Pancreatic metastases from ductal and lobular carcinomas of the breast.

The pancreas is an uncommon target for metastases from other primary tumours. We discuss clinical, diagnostic and therapeutic aspects of pancreatic metastases through presentation of two surgically treated cases of metastases originating from breast cancer.

Pancreatic metastases from ductal and lobular carcinomas of the breast

The pancreas is an uncommon target for metastases from other primary tumours. We discuss clinical, diagnostic and therapeutic aspects of pancreatic metastases through presentation of two surgically treated cases of metastases originating from breast cancer (AU)

[Epidermoid carcinoma on Zenker's diverticulum]. / Carcinoma epidermoide sobre un divertículo de Zenker.

Carcinoma is a rare but recognized complication of pharyngoesophageal diverticulum. We report the case of a 49-year-old man operated for a Zenker's diverticulum with an epidermoid carcinoma arising in the diverticulum. Since carcinoma is an uncommon complication of this pathology, we review the literature and discuss the therapeutic options.

Carcinoma epidermoide sobre un divertículo de Zenker / Spontaneous epidermoid carcinoma arising in Zenker´s diverticulum

El carcinoma es una complicación rara, pero posible, de los divertículos faringoesofágicos. Se presenta el caso de un paciente de 49 años intervenido quirúrgicamente por un divertículo de Zenker en cuyo interior se descubrió la presencia de un carcinoma epidermoide. Dado que se trata de una complicación muy poco frecuente de esta patología, se revisa la literatura y se discuten las opciones terapéuticas (AU)

Hamartoma quístico retrorrectal / Retrorectal cystic hamartoma

Se presenta el caso de un paciente de 38 años con historia de dolor perineal y con pruebas de diagnóstico preoperatorio sugestivas de tumoración quística retrorrectal. El paciente fue intervenido quirúrgicamente y el diagnóstico anatomopatológico fue de hamartoma quístico retrorrectal. Se discuten el diagnóstico y el tratamiento (AU)

Papillary cystic tumor of the pancreas coexisting with hairy cell leukemia.

The coexistence of a pancreatic papillary cystic tumor with hairy cell leukemia is reported. To the best of our knowledge this association has never been published. A 41-year-old man diagnosed with hairy cell leukemia developed a second malignancy that corresponded to a papillary cystic pancreatic tumor. The patient underwent splenectomy and a tumoral surgical resection, and is currently well at 21 months follow-up. A pathogenetic relationship between the two malignancies was not demonstrated. Hairy cell leukemia has been reported to be associated to a great number of different second malignancies. In contrast, only two papillary cystic tumors of the pancreas have been described associated to a second neoplasm, a papillary thyroid carcinoma and a colonic carcinoma. This unusual benign or low-grade malignant pancreatic tumor more commonly occurs in the tail of the pancreas of young women. We want to stress the unusual presentation of this pancreatic tumor affecting the head of the gland in a male patient as well as its coexistence with a hairy cell leukemia.

[Facial erythema and pancreatic glucagonoma]. / Eritema facial y glucagonoma pancreático.

Glucagonoma is a rare pancreatic tumor, that gives a characteristic clinical syndrome. In this report we describe the case of a 27 year old woman whose only clinical manifestations were a facial erythema and a palpable abdominal mass. Surgical removal of the tumor resulted in elimination of the clinical symptoms. Immunohistochemical findings were consistent with pancreatic glucagonoma.

Splenectomy for poor graft function after allogeneic bone marrow transplantation in patients with chronic myeloid leukemia.

We report four patients with chronic myeloid leukemia (CML) that showed poor graft function after a non-T-depleted bone marrow transplantation (BMT) from an HLA-compatible sibling donor and who were successfully treated with splenectomy. Conditioning was done with cyclophosphamide (CY) and total body irradiation (TBI) without additional splenic irradiation. Three patients had enlarged spleens before BMT. The nucleated cell dose infused ranged from 2.3-3.2 x 10(8)/kg. Bone marrow (BM) examination prior to splenectomy showed BM aplasia (three cases) or hypocellularity (one case). At splenectomy no patient had evidence of cytomegalovirus (CMV) infection or severe acute GVHD; and three patients had moderately enlarged spleens. All patients were transfusion dependent. Complete hematological recovery was obtained in all patients. BM cellularity was normal 1 month after splenectomy. Complete chimerism of donor origin was documented. The four patients are alive (+16 to +58 months after BMT). Thus, in patients with CML, a poor graft function may be successfully corrected by splenectomy.

[Congenital cysts of the choledochus]. / Quistes congénitos del colédoco.

We describe six cases of congenital choledochal cyst of the Toddani type I. All were female, with a mean age of 33.5 years (16-52). The onset of symptoms ranged 8-192 months (mean 92.8), with an unexpected finding. Ultrasound scan was performed in five patients, with two accurate diagnoses, one suspicious and two wrong results. In two cases a C.T. was performed and the diagnosis was confirmed in both. A cholelithiasis was associated in four cases. Four patients (66.4%) were treated by cyst excision, Roux-en-Y hepaticojejunostomy and cholecystectomy, three of them as a primary procedure, and one more after failure of some derivative operations. All evolved well but one, requiring sphincterotomy and Wirsungtomy. Two patients (33.6%) were treated by cholecystectomy only, with a favourable evolution. Nevertheless, we emphasize the good results achieved with cyst excision and we recommend it as the procedure of choice.