Intestinal Spirochetosis in an HIV-positive Patient.

We present the case of an HIV-positive patient admitted because of costal pain secondary to neoplasia. During investigations, a colonoscopy showed non-specific ulcerations. Histological examination resulted in a diagnosis of intestinal spirochetosis. This infection can be asymptomatic or cause non-specific symptoms such as diarrhoea or abdominal pain. Intestinal spirochetosis should be included in the differential diagnosis of colon lesions in patients with HIV infection. LEARNING POINTS: Intestinal spirochetosis is associated with chronic diarrhoea and often with normal colonoscopy.This infection should be included in the differential diagnosis of HIV patients with digestive symptomatology in the absence of other more frequent causes.

Free disease long-term survival in primary thoracic spine leiomyosarcoma after total en bloc spondylectomy: A case report.

INTRODUCTION: To describe an unusual primary vertebral leiomyosarcoma in thoracic spine. PRESENTATION OF CASE: An isolated lesion of the T11 vertebra in a 62-year-old woman with no neurologic deficit is reported. Imaging findings indicated a nonspecific high-grade malignant lesion. TC-guided biopsy failed thus open incisional biopsy was needed. A diagnosis of low-intermediate mesenchymal sarcoma was made. A total en bloc spondylectomy of T11 was performed with three-column reconstruction. The histology and immunostaining showed the appearance of leiomyosarcoma. After diagnosis, post-operative radiation therapy was performed. Metastatic lesion was ruled out by CT scans of the chest, abdomen and pelvis, in addition to total body radionuclide scanning and 18-F-FDG-PET. After five years of follow-up, no signs of local recurrence, metastasis or distant lesions suggesting a primary lesion were observed. DISCUSSION: Vertebral primary leiomyosarcoma is exceedingly rare. Primary vertebral leiomyosarcoma diagnosis must be performed when the metastatic origin is excluded. For the treatment of primary tumors, total en bloc spondylectomy (TES) is the technique of choice to achieve marginal or wide tumor resection, decrease the risk of local recurrence and remote lesions and increase survival. CONCLUSIONS: A well-planned pre-operative study and a wide surgical excision can result in local tumor control and long-term survival. This case presents the longest disease-free survival period of a primary leiomyosarcoma in spinal location after total en bloc spondylectomy.

Transformación maligna de un tumor odontogénico queratósico con gran componente inflamatorio. Presentación de un caso y revisión de la literatura / Primary intraosseous squamous cell carcinoma derived from a keratocystic odontogenic tumor with a large inflammatory component. Case report and a review of the literature

El desarrollo de un carcinoma de células escamosas a partir del revestimiento epitelial de un tumor odontogénico queratósico (TOQ) corresponde a una neoplasia maligna infrecuente exclusiva de los huesos maxilares, denominada también cómo carcinoma de células escamosas intraóseo primario (CCEIP). Afecta principalmente a personas de mediana edad, especialmente a hombres (2:1) y se localiza usualmente en la zona posterior de la mandíbula. Aunque la patogénesis del CCEIP es desconocida y no se le puede atribuir asociación con factores predisponentes para el desarrollo de carcinoma de células escamosas de la mucosa oral, actualmente se refuerza la idea del componente inflamatorio como predisponente de malignización. Se presenta un caso clinicopatológico de un varón de 61 años de edad con diagnóstico de CCEIP derivado de un TOQ con un gran componente inflamatorio asociado (AU)

The development of a squamous cell carcinoma from the epithelial lining of a keratotic odontogenic tumor (KOT) corresponds to a rare malignant neoplasm exclusive to the jawbone, also referred to as primary intraosseous squamous cell carcinoma (PIOC). It mainly affects middle-aged people, especially men (2: 1) and is usually located in the rear area of the jaw. The pathogenesis of PIOC is unknown and no predisposing factor for the development of squamous cell carcinoma of the oral mucosa has been identified. However, many authors support the hypothesis that a component of a chronic inflammatory process could prove to be the underlying factor of malignant change. We present a case of a 61-year-old male diagnosed with PIOC derived from a KOT associated with an extensive inflammatory process (AU)

Intractable hematuria secondary to systemic amyloidosis with bladder involvement.

OBJECTIVE: To present the therapeutic management of intractable hematuria secondary to systemic amyloidosis with bladder involvement. METHODS: We describe the clinical case, the medical management, the endo-urological technique used, and the results supported by relevant published literature. RESULTS: A 50-year-old woman with a 20-year history of rheumatoid arthritis in chronic treatment with corticosteroids and non-steroidal anti-inflammatory drugs in addition to chronic renal insufficiency not requiring hemodialysis. Twenty-four hours after resection of a hepatic hydatid cyst she presented intractable hematuria. The ultrasound and CT scan showed the formation of a large blood clot in the bladder not affecting the upper urinary tract. An intra-operative cystoscopy revealed a distended bladder showing signs of inflammation with diffuse, widespread bleeding. Hemostasis was achieved and a biopsy of the mucosa was taken, associated to bladder irrigation with potassium alum as a hemostatic. Given the persistence of the hematuria, further revision in the operating room as well as blood transfusion were carried out and, due to the hemodynamic instability that could not be controlled, finally selective embolization was performed. Intravesical instillation of dimethyl sulphoxide every 72 hours was used to control any remaining hematuria. The biopsy showed bladder amyloidosis. The addition of intravenous steroids and orally administered colchicine successfully controlled the patient's clinical status. CONCLUSIONS: Secondary amyloidosis of the bladder is a condition associated with hematuria that is difficult to manage. Hematuria control is often difficult, requiring aggressive treatment in addition to more conservative approaches.

Hematuria incoercible generada en la amiloidosis sistémica con afectación vesical / Intractable hematuria secondary to systemic amyloidosis with bladder involvement

OBJETIVO: Presentar el manejo terapéutico de la hematuria incoercible generada en la amiloidosis sistémica con afectación vesical. MÉTODO: Descripción del caso clínico, el manejo médico, la técnica endourológica utilizada y de los resultados con apoyo de la literatura publicada al respecto. RESULTADOS: Mujer de 50 años con antecedentes personales de artritis reumatoide (AR) de 20 años de evolución en tratamiento crónico con corticoides y AINES así como insuficiencia renal crónica sin necesidad de hemodiálisis, que tras 24 horas de la resección de un quiste hidatídico hepático presenta hematuria incoercible. Ecografía y TAC revelan gran coágulo vesical organizado sin repercusión de la vía urinaria. La cistoscopia intraoperatoria muestra una vejiga distendida de aspecto inflamatorio con sangrado difuso generalizado. Se realiza hemostasia y toma de biopsias de la mucosa asociando al lavado vesical alumbre potásico como hemostático. Dada la persistencia de la hematuria se procede a nueva revisión en quirófano más transfusión de hemoderivados en vista de la inestabilidad hemodinámica sin lograr control de la misma por lo que se realiza embolización selectiva. Se asocia instilación vesical con DMSO cada 72 hrs. para el control de la hematuria remanente. La biopsia revela el hallazgo de amiloidosis vesical agregándose al tratamiento corticoide intravenoso y colchicina oral controlando satisfactoriamente la clínica de la paciente. CONCLUSIONES: La amiloidosis vesical secundaria es una entidad que cursa con hematuria de difícil manejo. El control de la hematuria suele ser difícil por lo que además de los tratamientos conservadores a veces requiere de tratamientos más agresivos

OBJECTIVE: To present the therapeutic management of intractable hematuria secondary to systemic amyloidosis with bladder involvement. METHODS: We describe the clinical case, the medical management, the endo-urological technique used, and the results supported by relevant published literature. RESULTS: A 50-year-old woman with a 20-year history of rheumatoid arthritis in chronic treatment with corticosteroids and non-steroidal anti-inflammatory drugs in addition to chronic renal insufficiency not requiring hemodialysis. Twenty-four hours after resection of a hepatic hydatid cyst she presented intractable hematuria. The ultrasound and CT scan showed the formation of a large blood clot in the bladder not affecting the upper urinary tract. An intra-operative cystoscopy revealed a distended bladder showing signs of inflammation with diffuse, widespread bleeding. Hemostasis was achieved and a biopsy of the mucosa was taken, associated to bladder irrigation with potassium alum as a hemostatic. Given the persistence of the hematuria, further revision in the operating room as well as blood transfusion were carried out and, due to the hemodynamic instability that could not be controlled, finally selective embolization was performed. Intravesical instillation of dimethyl sulphoxide every 72 hours was used to control any remaining hematuria. The biopsy showed bladder amyloidosis. The addition of intravenous steroids and orally administered colchicine successfully controlled the patient’s clinical status. CONCLUSIONS: Secondary amyloidosis of the bladder is a condition associated with hematuria that is difficult to manage. Hematuria control is often difficult, requiring aggressive treatment in addition to more conservative approaches