Metástasis mamaria de un adenocarcinoma mucinoso de colon: descripción de un caso y revisión de la literatura / Breast metastasis from mucinous adenocarcinoma of the colon: a case report and review of the literature

Objetivo. Determinar las características de las metástasis mamarias colorrectales para realizar un diagnóstico diferencial y un tratamiento adecuados. Caso clínico. Se presenta un caso de metástasis mamaria de un adenocarcinoma mucinoso de colon y se realiza un análisis de las características patológicas, radiológicas, de localización, latencia y supervivencia de los otros 34 casos publicados en la literatura. Resultados. La edad media al diagnóstico es de 53,3 años. Son tumores avanzados (el 48% en estadio C de Dukes y el 24% en estadio D) y el 75%, asociados a enfermedad metastásica difusa. Existe disparidad en el tratamiento realizado; en 12 no se realiza cirugía, en 7 se trata solo la lesión y en 4 casos más se estadifica también la axila. Conclusiones. Las metástasis en la mama de un primario de colon es una afección a tener en cuenta en el diagnóstico diferencial de las tumoraciones mamarias. La imagen radiológica características es una masa mamaria bien definida sin microcalcificaciones. El uso de citoqueratina 7 y 20 y los anticuerpos CDX2 y mamoglobina permiten diagnosticar el origen de la tumoración. El tratamiento debe ser individualizado y llevado a cabo por un equipo multidisciplinar, ya que en el caso de metástasis única no debe ser considerada una enfermedad diseminada (AU)

Objective. To determine the characteristics of breast metastasis of colorectal origin in order to aid suitable differential diagnosis and treatment. Case report. We present a case of breast metastasis from a mucinous colon adenocarcinoma and describe the pathological and radiological characteristics, location, latency and survival of the other 34 cases reported in the literature. Results. The mean age at diagnosis was 53.3 years. The tumours were typically advanced (Dukes stage C in 48% and stage D in 24%) and 75% were associated with metastatic disease in other locations. There was wide disparity in the treatment provided; surgery was not performed in 12, only the lesion was treated in 7, and the axilla was also staged in 4. Conclusions. Metastases to the breast from a primary colon cancer is rare but should be considered in the differential diagnosis of mammary tumours. The radiological image is a well-defined breast mass usually without microcalcifications. Currently, the use of cytokeratin 7 and 20, CDX2 monoclonal antibodies and mammaglobin allows clear differentiation of the origin of the tumour. Treatment must be individualized and undertaken by a multidisciplinary team, because, in the case of single metastasis, they should not be considered a widely disseminated disease (AU)

Real-time fluorogenic reverse transcription polymerase chain reaction assay for the specific detection of Bagaza virus.

In September 2010, an outbreak of disease in 2 wild bird species (red-legged partridge, Alectoris rufa; ring-necked pheasant, Phasianus colchicus) occurred in southern Spain. Bagaza virus (BAGV) was identified as the etiological agent of the outbreak. BAGV had only been reported before in Western Africa (Central African Republic, Senegal) and in India. The first occurrence of BAGV in Spain stimulated a demand for rapid, reliable, and efficacious diagnostic methods to facilitate the surveillance of this disease in the field. This report describes a real-time reverse transcription polymerase chain reaction (RT-PCR) method based on a commercial 5'-Taq nuclease-3' minor groove binder DNA probe and primers targeting the Bagaza NS5 gene. The method allowed the detection of BAGV with a high sensitivity, whereas other closely related flaviviruses (Usutu virus, West Nile virus, and Japanese encephalitis virus) were not detected. The assay was evaluated using field samples of red-legged partridges dead during the outbreak (n = 11), as well as samples collected from partridges during surveillance programs (n = 81). The results were compared to those obtained with a pan-flaviviral hemi-nested RT-PCR followed by nucleotide sequencing, which was employed originally to identify the virus involved in the outbreak. The results obtained with both techniques were 100% matching, indicating that the newly developed real-time RT-PCR is a valid technique for BAGV genome detection, useful in both diagnosis and surveillance studies.

Factores que afectan a la recurrencia postoperatoria de la enfermedad de Crohn. Nuevas controversias a través de la experiencia de un centro / No disponible

Introducción Muchos pacientes con enfermedad de Crohn presentan recurrencias frecuentes mientras otros mantienen periodos prolongados de remisión después de la cirugía. Determinar los factores de riesgo de recidiva puede ser útil para identificar pacientes de alto riesgo y poder adoptar estrategias adecuadas durante el acto quirúrgico y en la elección del tratamiento médico postoperatorio. Material y métodos Estudio retrospectivo de 78 pacientes con enfermedad de Crohn ileocólica sometidos a una primera cirugía resectiva durante el periodo de enero de 2000 a diciembre de 2005; posteriormente se han estudiado los factores de riesgo de recurrencia endoscópica, radiológica y quirúrgica hasta mayo de 2009. Resultados 41 pacientes (52,6%) tuvieron recurrencia; siendo en 17 pacientes (21,8%) endoscópica, en 12 (15,4%) radiológica y en 12 (15,4%) quirúrgica. El tiempo medio de la primera recurrencia es de 70,24 meses. El no realizar anastomosis durante la cirugía resectiva parece tener más relación con la existencia de recidiva (77,7% vs 48,2%). Aunque solo la existencia de complicaciones postoperatorias (p=0,018) tiene relación significativa con la existencia de recurrencia (68,4% vs 47,4%) así como la necesidad de transfusión en el periodo postoperatorio inmediato (67,8% vs 42,8%). Conclusiones La transfusión de hemoderivados es un factor de riesgo para la recurrencia postoperatoria de la enfermedad de Crohn. Pero solo las complicaciones postoperatorias se muestran como factor de riesgo independiente en el análisis multivariable. Una técnica quirúrgica adecuada y segura es un factor perioperatorio muy importante en el que podemos influir para disminuir esta recidiva (AU)

Introduction: Many patients with Crohn’s disease have frequent recurrences, while others have long periods of remission after surgery. Determination of the risk factors of recurrence would be useful in identifying these high risk patients and to adopt suitable strategies during the surgical act and in the choice of post-surgical medical treatment. Material and methods: A retrospective study was conducted on 78 patients with ileocolic Crohn’s disease subjected to a first surgical resection, during the period from January 2000 to December 2005. The risk factors for endoscopic, radiological and surgical were subsequently analysed up to May 2009.Results: A total of 41 patients (52.6%) had recurrences, being endoscopic in 17 (21.8%) of patients, radiological in 12 (15.4%) and surgical in 12 (15.4%). The mean time to first recurrence was 70.24 months. Recurrence was associated more to not performing anastomosis(77.7% vs. 48.2%) during surgical resection. Although only the existence of postoperative complications (P = .018) was significantly associated with (68.4% vs. 47.4%), as well as with the need for transfusion in the immediate post-operative period (67.8% vs. 42.8%). Conclusions: Transfusion of blood products is a risk factor for postoperative recurrence of Crohn’s disease. But only postoperative complications are shown as an independent risk factor in the multivariate analysis. An adequate and safe surgical technique is a very important perioperative factor over which we have the influence to decrease these recurrences (AU)

[Factors affecting the postoperative recurrence of Crohn's disease. New controversies with one centre's experience]. / Factores que afectan a la recurrencia postoperatoria de la enfermedad de Crohn. Nuevas controversias a través de la experiencia de un centro.

INTRODUCTION: Many patients with Crohn's disease have frequent recurrences, while others have long periods of remission after surgery. Determination of the risk factors of recurrence would be useful in identifying these high risk patients and to adopt suitable strategies during the surgical act and in the choice of post-surgical medical treatment. MATERIAL AND METHODS: A retrospective study was conducted on 78 patients with ileocolic Crohn's disease subjected to a first surgical resection, during the period from January 2000 to December 2005. The risk factors for endoscopic, radiological and surgical were subsequently analysed up to May 2009. RESULTS: A total of 41 patients (52.6%) had recurrences, being endoscopic in 17 (21.8%) of patients, radiological in 12 (15.4%) and surgical in 12 (15.4%). The mean time to first recurrence was 70.24 months. Recurrence was associated more to not performing anastomosis (77.7% vs. 48.2%) during surgical resection. Although only the existence of postoperative complications (P=.018) was significantly associated with (68.4% vs. 47.4%), as well as with the need for transfusion in the immediate post-operative period (67.8% vs. 42.8%). CONCLUSIONS: Transfusion of blood products is a risk factor for postoperative recurrence of Crohn's disease. But only postoperative complications are shown as an independent risk factor in the multivariate analysis. An adequate and safe surgical technique is a very important perioperative factor over which we have the influence to decrease these recurrences.

Two Doses of oxaliplatin with capecitabine (XELOX) in metastatic colorectal cancer.

PURPOSE: Phase II/III studies have shown XELOX to be as effective as FOLFOX in patients with advanced colorectal cancer (CRC). The study was designed to evaluate the activity and tolerability of XELOX in CRC. In August 2002, we began a prospective study of XELOX as first-line therapy for patients with metastatic CRC. Twenty-two patients were enrolled between November 2002 and August 2003 (series I). An interim analysis performed in August 2003 revealed that 32% of patients required a dose reduction of oxaliplatin because of toxicity. From August 2003 to April 2005, an additional 20 patients were included (series II). This second group of patients received oxaliplatin at a lower dose. PATIENTS AND METHODS: The first 22 patients (series I) included received oxaliplatin 130 mg/m(2) on day 1 plus capecitabine 2000 mg/m(2) daily on days 1-15 (3-week cycle). The second set of 20 patients (series II) received oxaliplatin 85 mg/m(2) on day 1; the dose of capecitabine and the frequency of administration were not modified. RESULTS: Patient characteristics were well balanced in the 2 series. Overall response (series I vs. II): 41% vs. 65%; median time to progression was similar: 10.51 vs. 10.92 (log-rank test, P = .79). Median survival was similar in the 2 series: 19.55 vs. 21.18 months (log-rank test, P = .61). Grade 3/4 toxicity (series I vs. II): peripheral neuropathy, 14% vs. 0 (P = .23). CONCLUSION: In patients with advanced CRC, in combination with capecitabine, oxaliplatin 85 mg/m(2) is as effective with lower toxicity when compared with oxaliplatin 130 mg/m(2).

Single nucleotide polymorphisms in nucleotide excision repair genes XPA, XPD, XPG and ERCC1 in advanced colorectal cancer patients treated with first-line oxaliplatin/fluoropyrimidine.

BACKGROUND/AIMS: Oxaliplatin damages the DNA, leading to apoptosis. XPA, XPD, ERCC1 and XPG genes are involved in DNA repair, and single nucleotide polymorphisms (SNPs) in these genes can influence the efficacy of oxaliplatin. We examined SNPs in these genes and correlated the results with time to progression (TTP), overall survival and response to oxaliplatin in 42 advanced colorectal cancer patients (CRC) treated with first-line oxaliplatin/fluoropyrimidine. METHODS: DNA was obtained from peripheral blood cells, and the allelic discrimination assay was used to analyze the XPA 5'UTR T/C, XPD Lys751Gln, ERCC1 Lys259Thr and XPG, C/T. RESULTS: Patients with XPG C/C genotype had a longer survival (p = 0.001) and TTP (p = 0.009) than patients with XPG C/T or T/T genotypes, and patients with both XPG C/C and XPA T/C or C/C genotypes had a longer survival (p = 0.0001) and TTP (p = 0.0001) than patients with other genotypes. XPG (CC) combined with XPA (TC/CC) genotypes showed an independent role for TTP (relative risk, RR = 6.38; p = 0.0001) and survival (RR = 34; p = 0.0005). CONCLUSION: Polymorphism in XPG combined with XPA may be an important prognosticator of clinical outcome following oxaliplatin/ fluoropyrimidine chemotherapy. Further studies in larger patient cohorts are warranted to confirm their role in CRC.