Role of endoscopic ultrasound in the diagnosis of pancreatic cancer.

Endoscopic ultrasonography (EUS) with or without fine needle aspiration has become the main technique for evaluating pancreatobiliary disorders and has proved to have a higher diagnostic yield than positron emission tomography, computed tomography (CT) and transabdominal ultrasound for recognising early pancreatic tumors. As a diagnostic modality for pancreatic cancer, EUS has proved rates higher than 90%, especially for lesions less than 2-3 cm in size in which it reaches a sensitivity rate of 99% vs 55% for CT. Besides, EUS has a very high negative predictive value and thus EUS can reliably exclude pancreatic cancer. The complication rate of EUS is as low as 1.1%-3.0%. New technical developments such as elastography and the use of contrast agents have recently been applied to EUS, improving its diagnostic capability. EUS has been found to be superior to the recent multidetector CT for T staging with less risk of overstaying in comparison to both CT and magnetic resonance imaging, so that patients are not being ruled out of a potentially beneficial resection. The accuracy for N staging with EUS is 64%-82%. In unresectable cancers, EUS also plays a therapeutic role by means of treating oncological pain through celiac plexus block, biliary drainage in obstructive jaundice in patients where endoscopic retrograde cholangiopancreatography is not affordable and aiding radiotherapy and chemotherapy.

Metástasis pancreática única de carcinoma renal / Solitary pancreatic metastasis from renal carcinoma

Presentamos el caso de un varón de 60 años, con antecedentes de nefrectomía radical izquierda por carcinoma renal, en grado nuclear II de Fuhrman, 8 años atrás. Por traumatismo abdominal cerrado se solicitó una TC abdominal en la que se observó una lesión sólida, hipervascular en la cabeza pancreática de 4cm de diámetro. Con la sospecha diagnóstica de metástasis pancreática de carcinoma renal se realizó duodenopancreatectomía cefálica con preservación pilórica. El estudio anatomopatológico confirmó la presunción diagnóstica. A los 23 meses de seguimiento el paciente está libre de enfermedad (AU)

We present the case of a 60-year-old man with a history of left radical nephrectomy due to Fuhrman nuclear grade II renal carcinoma 8 years previously. Abdominal computed tomography was performed due to a closed abdominal injury, revealing a solid, 4-cm hypervascular mass in the head of the pancreas. The suspected diagnosis was pancreatic metastasis from renal carcinoma. Cephalic duodenopancreatectomy was performed. The diagnosis was confirmed by histopathological analysis. At 23 months of follow-up, the patient remains disease free (AU)

Causa poco frecuente de úlcera gástrica / A rare cause of gastric ulcer

Las lesiones del tracto gastrointestinal inducidas por fármacos son cada vez más frecuentes, pero en general poco reconocidas. Aunque hay un número elevado de fármacos que se asocian con efectos adversos gastrointestinales, hay limitados patrones característicos de los mismos. La gastritis aguda isquémica es una entidad poco común que rara vez se distingue de otras formas de isquemia intestinal. Presentamos el caso de una mujer de 69 años que en el contexto de una reagudización de su anemia, encontramos una lesión gástrica poco común (AU)

Drug-induced gastrointestinal tract lesions are becoming more frequent but are generally little known. Although a large number of drugs have gastrointestinal adverse effects, there are few characteristic patterns. Acute ischemic gastritis is an uncommon entity that is rarely distinguished from other forms of intestinal ischemia. We report the case of a 69-year-old woman who was diagnosed with an unusual gastric lesion in the context of an acute exacerbation of her anemia (AU)

[A rare cause of gastric ulcer]. / Causa poco frecuente de úlcera gástrica.

Drug-induced gastrointestinal tract lesions are becoming more frequent but are generally little known. Although a large number of drugs have gastrointestinal adverse effects, there are few characteristic patterns. Acute ischemic gastritis is an uncommon entity that is rarely distinguished from other forms of intestinal ischemia. We report the case of a 69-year-old woman who was diagnosed with an unusual gastric lesion in the context of an acute exacerbation of her anemia.

[Primary esophageal melanoma]. / Melanoma esofagico primario.

Primary Esophageal Melanoma (PEM) is an extremely rare neoplasm, with less than 270 cases described. Although clinical presentation is similar to any other esophageal neoplasm, MEP's behavior is more aggressive and fatal in most cases. We report two new cases of MEP diagnosed through endoscopy and anatomical-pathological analysis of collected biopsies. Both samples were positive for HMB-45 and S100, so the presence of primary melanoma in other location was ruled out. The form of presentation as left miosis with no eyelid ptosis or enophthalmos should be highlighted in the first case, which was described by this early manifestation. Unfortunately, the neoplasm could not be excised when diagnosed because the thoracic artery was found to be affected through echoendoscopy. In the second case, in spite of the fact that the neoplastic extension was only local, and neoplasm was subject to transhiatal esophagectomy, the patient had multiple post-surgical complications and died nineteen days after the surgical procedure. Furthermore, bibliographic review is applied to diagnosis, treatment options, and prognosis of this exceptional neoplasm.

Melanoma esofágico primario / Primary esophageal melanoma

El melanoma esofágico primario (MEP) es una neoplasia extremadamente rara, con menos de 270 casos descritos. Aunque la presentación clínica es similar a cualquier otra neoplasia esofágica, su comportamiento es más agresivo y fatal en la mayoría de los casos. Presentamos dos nuevos casos de MEP diagnosticados mediante endoscopia y estudio anatomopatológico de las biopsias obtenidas, siendo en ambos casos las muestras positivas para HMB-45 y S100, descartando así mismo la presencia de melanoma primario en otra localización. En el primer caso merece destacar la forma de presentación como miosis izquierda sin ptosis palpebral ni enoftalmos, siendo el primer caso descrito con esta manifestación inicial, lamentablemente al momento del diagnóstico fue irresecable, demostrando así mismo por ecoendoscopia afectación de la aorta torácica. El segundo caso a pesar de ser una neoplasia sin extensión locorregional y sometido a esofaguectomía transhiatal presentó múltiples complicaciones postoperatorias falleciendo al decimo noveno día de la intervención. Así mismo se hace una revisión bibliográfica sobre diagnóstico, opciones de tratamiento y pronóstico de esta excepcional neoplasia.

Primary Esophageal Melanoma (PEM) is an extremely rare neoplasm, with less than 270 cases described. Although clinical presentation is similar to any other esophageal neoplasm, MEP's behavior is more aggressive and fatal in most cases. We report two new cases of MEP diagnosed through endoscopy and anatomical-pathological analysis of collected biopsies. Both samples were positive for HMB-45 and S100, so the presence of primary melanoma in other location was ruled out. The form of presentation as left miosis with no eyelid ptosis or enophthalmos should be highlighted in the first case, which was described by this early manifestation. Unfortunately, the neoplasm could not be excised when diagnosed because the thoracic artery was found to be affected through echoendoscopy. In the second case, in spite of the fact that the neoplastic extension was only local, and neoplasm was subject to transhiatal esophagectomy, the patient had multiple post-surgical complications and died nineteen days after the surgical procedure. Furthermore, bibliographic review is applied to diagnosis, treatment options, and prognosis of this exceptional neoplasm.