Adenocarcinoma de recto y ano en paciente con enfermedad de Crohn tratado con infliximab / Adenocarcinoma of the rectum and anus in a patient with Crohn's disease treated with infliximab

Presentamos el caso de un paciente con enfermedad de Crohnde larga evolución y con múltiples complicaciones de su enfermedadque, tras recibir tratamiento con infliximab, es diagnosticadode un adenocarcinoma de recto y ano que precisa cirugía radical,presentando posteriormente metástasis múltiples. Se repasarándurante la discusión las características y los factores de riesgo másimportantes del cáncer colorrectal en pacientes con enfermedadinflamatoria intestinal, y se analizarán los trabajos existentes hastala fecha en relación con la aparición de neoplasias en pacientestratados con fármacos biológicos(AU)

In the present paper, we report the case of a patient with longstandingCrohn’s disease and multiple complications that, after receivingtreatment with infliximab, was diagnosed with an adenocarcinomaof the rectum and anus that required radical surgery,later presenting multiple metastases. In the discussion, characteristicsand major risk factors for colorectal cancer in patients withinflammatory bowel disease will be largely reviewed, and currentstudies will be analyzed in connection with the appearance of neoplasmsin patients being treated with biologics(AU)

Adenocarcinoma of the rectum and anus in a patient with Crohn's disease treated with infliximab.

In the present paper, we report the case of a patient with long-standing Crohn s disease and multiple complications that, after receiving treatment with infliximab, was diagnosed with an adenocarcinoma of the rectum and anus that required radical surgery, later presenting multiple metastases. In the discussion, characteristics and major risk factors for colorectal cancer in patients with inflammatory bowel disease will be largely reviewed, and current studies will be analyzed in connection with the appearance of neoplasms in patients being treated with biologics.

Pancreatitis aguda, hipercalcemia y ecografía cervical / Acute pancreatitis, hyperkalcemia and cervical ultrasound

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Bilateral pulmonary thromboembolism and Budd-Chiari syndrome in a patient with Crohn s disease on oral contraceptives.

Budd-Chiari syndrome can be defined as an interruption or diminution of the normal blood flow out of the liver. Patients with Budd-Chiari syndrome present with varying degrees of symptomatology that can be divided into the following categories: fulminant, acute, subacute and chronic. The subacute form is the most common presentation. A majority of patients with Budd-Chiari syndrome have an underlying hypercoagulability state. We present the case of a young woman with Crohn s disease on oral contraceptives who developed bilateral pulmonary thromboembolism and Budd-Chiari syndrome.

Tromboembolismo de pulmón bilateral y síndrome de Budd-Chiari en paciente con enfermedad de Crohn y toma de anticonceptivos orales / Bilateral pulmonary thromboembolism and Budd-Chiari syndrome in a patient with Crohn’s disease on oral contraceptives

El síndrome de Budd-Chiari consiste en la interrupción o disminuciónde flujo de las venas suprahepáticas. Tiene una gran variabilidadclínica en cuanto a su forma de presentación siendo la másfrecuente la forma subaguda. La gran mayoría de los pacientesresponden a estados de hipercoagulabilidad. Presentamos el casode una paciente joven con enfermedad de Crohn que estaba entratamiento con anticonceptivos orales y desarrolló un cuadro clínicode tromboembolismo de pulmón bilateral y síndrome deBudd-Chiari(AU)

Budd-Chiari syndrome can be defined as an interruption or diminutionof the normal blood flow out of the liver. Patients withBudd-Chiari syndrome present with varying degrees of symptomatologythat can be divided into the following categories: fulminant,acute, subacute and chronic. The subacute form is the mostcommon presentation. A majority of patients with Budd-Chiarisyndrome have an underlying hypercoagulability state. We presentthe case of a young woman with Crohn’s disease on oralcontraceptives who developed bilateral pulmonary thromboembolismand Budd-Chiari syndrome(AU)

Hepatic angiosarcoma. Presentation of two cases.

Hepatic angiosarcoma is a rare primary tumor of the liver with a mesenchymal origin. Diagnosis is difficult because clinical manifestations and imaging studies are inconclusive. In many cases a diagnosis is obtained during necropsy, not being apparent during the course of disease. It is associated with several risk factors, but these contribute to explaining only a few of all reported cases. When clinical manifestations begin progression is often fast, and possibilities for curative treatment are limited.We report two cases of hepatic angiosarcoma. In the first one, our patient had an insidious initial course, and then suddenly presented with hepatic failure followed by acute respiratory distress. A diagnosis was reached during necropsy. In the second case, we initiated the study of a chronic liver disease using fine-needle aspiration biopsy, which showed findings suggestive of hepatic angiosarcoma. In the following weeks the patient started on a torpid clinic course, and died from multiple organ failure.

Angiosarcoma hepático. Presentación de dos casos / Hepatic angiosarcoma: Presentation of two cases

El angiosarcoma hepático es una neoplasia de estirpe mesenquimal de baja frecuencia y difícil diagnóstico por su forma inespecífica de manifestarse clínica y radiológicamente. Tanto es así que muchos diagnósticos se obtienen mediante necropsia, no siendo posible poner de manifiesto la enfermedad durante su curso. Se asocia a diferentes agentes etiológicos, pero en la mayoría de los casos no es posible establecer una exposición concreta a ninguno de ellos. Cuando comienza a manifestarse, la evolución suele ser rápida y las opciones de tratamiento curativo son escasas. Presentamos en nuestro trabajo dos casos de angiosarcoma hepático. En el primero, el paciente sufre en principio una evolución insidiosa, presentando al fin, y de forma abrupta, un cuadro de insuficiencia hepática seguido de distrés respiratorio, falleciendo por este motivo. El diagnóstico se alcanza en la necropsia. En el segundo caso se inicia un estudio de hepatopatía en el cual se indica una PAAF. Esta es informada como hallazgos compatibles con angiosarcoma hepático. El paciente presenta en las semanas ulteriores una evolución tórpida, falleciendo en fracaso multiorgánico(AU)

Hepatic angiosarcoma is a rare primary tumor of the liver with a mesenchymal origin. Diagnosis is difficult because clinical manifestations and imaging studies are inconclusive. In many cases a diagnosis is obtained during necropsy, not being apparent during the course of disease. It is associated with several risk factors, but these contribute to explaining only a few of all reported cases. When clinical manifestations begin progression is often fast, and possibilities for curative treatment are limited. We report two cases of hepatic angiosarcoma. In the first one, our patient had an insidious initial course, and then suddenly presented with hepatic failure followed by acute respiratory distress. A diagnosis was reached during necropsy. In the second case, we initiated the study of a chronic liver disease using fine-needle aspiration biopsy, which showed findings suggestive of hepatic angiosarcoma. In the following weeks the patient started on a torpid clinic course, and died from multiple organ failure(AU)

Acute pancreatitis associated with hypercalcemia. A report of two cases.

Hypercalcemia due to hyperparathyroidism is a rare etiology for acute pancreatitis, oscillating between 1.5 and 7% in the different series. Although the cause-effect relationship and the pathophysiology of the condition are not clear, it seems that the association among them is not incidental, and serum calcium could be a major risk factor, so that pancreatitis would come to occur during severe hypercalcemia attacks. Mutations in different genes have been proposed as well to justify why only some patients with primary hyperparathyroidism and hypercalcemia develop acute pancreatitis. References to cases like these ones are rare in the literature. We report two patients with acute pancreatitis associated with hyperparathyroidism and hypercalcemia, one of them with a fatal outcome.

Pancreatitis aguda asociada a hipercalcemia. Presentación de dos casos / Acute pancreatitis associated with hypercalcemia: a report of two cases

La hipercalcemia secundaria a hiperparatiroidismo es una causarara de pancreatitis aguda, variando entre el 1,5-7% según lasseries consultadas. Aunque la relación causal y la fisiopatología delproceso no están totalmente aclaradas, parece claro que la asociaciónno es incidental y que los niveles de calcio sérico serían unfactor de riesgo mayor, desencadenándose los cuadros de pancreatitisdurante las crisis de hipercalcemia. También se han descritoalteraciones en diversos genes que podrían estar implicados,justificando por qué sólo unos pocos pacientes con hiperparatiroidismoprimario e hipercalcemia sufren pancreatitis aguda.Existen muy pocas referencias en la literatura a casos como losque nos ocupan. Presentamos a continuación dos pacientes concuadros de pancreatitis aguda asociados a hiperparatiroidismo ehipercalcemia, uno de ellos con desenlace fatal(AU)

Hypercalcemia due to hyperparathyroidism is a rare etiology for acute pancreatitis, oscillating between 1.5 and 7% in the different series. Although the cause-effect relationship and the pathophysiology of the condition are not clear, it seems that the association among them is not incidental, and serum calcium could be a major risk factor, so that pancreatitis would come to occur during severe hypercalcemia attacks. Mutations in different genes have been proposed as well to justify why only some patients with primary hyperparathyroidism and hypercalcemia develop acute pancreatitis. References to cases like these ones are rare in the literature. We report two patients with acute pancreatitis associated with hyperparathyroidism and hypercalcemia, one of them with a fatal outcome(AU)