How to avoid iatrogenic injuries of the biliary tract in urgent surgery? The use of indocianine green is an alternative.

Iatrogenic bile duct injury is a rare complication, although feared due to its morbidity and mortality. In urgent surgeries, its incidence can be doubled, so in selected cases we must assess the use of resources such as indocyanine green to minimize the risk of biliary or arterial lesions by allowing the correct identification of the structures. We present the case of a 57-year-old patient with acute cholecystitis who underwent laparoscopic cholecystectomy. Given the difficulty in differentiating structures in Calot's triangle, the decision was made to use indocyanine green, which identifies a very short cystic duct, thus avoiding iatrogenic bile duct injury.

La lesión iatrogénica de vía biliar es una complicación infrecuente, aunque temida por su morbimortalidad. En cirugías urgentes, su incidencia puede duplicarse, por lo que en casos seleccionados debemos valorar la utilización de recursos como el verde de indocianina para minimizar el riesgo de lesiones biliares o arteriales, al permitir una correcta identificación de las estructuras. Presentamos el caso de una paciente de 57 años con colecistitis aguda a la que realizamos colecistectomía laparoscópica. Ante la dificultad en la diferenciación de estructuras en el triángulo de Calot, se decidió utilizar verde de indocianina, que identificó un conducto cístico muy corto, evitando así una lesión iatrogénica de vía biliar.

Acute emphysematous cholecystitis due to clostridium perfringens: a rare entity requiring aggressive and early treatment.

Acute emphysematous cholecystitis is a rare entity (1% of acute cholecystitis) characterized by the presence of gas in the gallbladder lumen, gallbladder wall or even in the bile duct (pneumobilia). It is associated with arteriosclerosis, embolic events, and diabetes mellitus and as in other similar pathologies such as emphysematous gastritis or emphysematous pancreatitis the most frequently isolated microorganisms are Streptococcus pyogenes, Escherichia coli and Staphylococcus aureus, although others such as Proteus vulgaris, Pseudomonas aeruginosa, Clostridium perfringens and Klebsiella pneumoniae have also been found.

Liver metastases of a malignant solitary fibrous tumor: the important role of immunohistochemistry in this rare entity.

Solitary fibrous tumor (SFT) is a rare neoplasm of mesenchymal origin that normally appears in the pleura; however, it has been described in other extrapleural locations. This tumor is rarely malignant and only a few cases of metastatic SFT have been described.

Importance of immunohistochemistry in the differential diagnosis of gastric stromal tumors: GIST vs. schwannoma.

The intention of this work is to present a recent case treated in our center. A 77-year-old woman who underwent a laparoscopic subtotal gastrectomy due to the suspicion of a GIST tumor (gastrointestinal stromal tumor), in which the anatomy study the definitive pathology showed the finding of gastric Shawnnoma.

Deep Phenotypic Characterisation of CTCs by Combination of Microfluidic Isolation (IsoFlux) and Imaging Flow Cytometry (ImageStream).

The isolation of circulating tumour cells (CTCs) in colorectal cancer (CRC) mostly relies on the expression of epithelial markers such as EpCAM, and phenotypic characterisation is usually performed under fluorescence microscopy with only one or two additional markers. This limits the ability to detect different CTC subpopulations based on multiple markers. The aim of this work was to develop a novel protocol combining two platforms (IsoFluxTM and ImageStream®X) to improve CTC evaluation. Cancer cell lines and peripheral blood from healthy donors were used to evaluate the efficiency of each platform independently and in combination. Peripheral blood was extracted from 16 early CRC patients (before loco-regional surgery) to demonstrate the suitability of the protocol for CTC assessment. Additionally, peripheral blood was extracted from nine patients one month after surgery to validate the utility of our protocol for identifying CTC subpopulation changes over time. Results: Our protocol had a mean recovery efficiency of 69.5% and a limit of detection of at least four cells per millilitre. We developed an analysis method to reduce noise from magnetic beads used for CTC isolation. CTCs were isolated from CRC patients with a median of 37 CTCs (IQ 13.0-85.5) at baseline. CTCs from CRC patients were significantly (p < 0.0001) larger than cytokeratin (CK)-negative cells, and patients were stratified into two groups based on BRAFV600E and PD-L1 expression on CK-positive cells. The changes observed over time included not only the number of CTCs but also their distribution into four different subpopulations defined according to BRAFV600E and PD-L1 positivity. We developed a novel protocol for semi-automatic CTC isolation and phenotypic characterisation by combining two platforms. Assessment of CTCs from early CRC patients using our protocol allowed the identification of two clusters of patients with changing phenotypes over time.

Dolor abdominal secundario a disección espontánea de arteria mesentérica superior complicada / Abdominal pain at complicated spontaneous superior mesenteric artery dissection

La disección espontánea de la arteria mesentérica superior (AMS) es una entidad que se describe como un desgarro o rotura de la íntima y de las capas internas de la media permitiendo el paso de sangre creando una luz falsa en la capa media. El diagnóstico clínico se establece tras la aparición de dolor abdominal súbito en pacientes con factores de riesgo cardiovascular y su manejo puede ser endovascular o mediante cirugía a cielo abierto, dependiendo de diversos factores que mencionaremos. La clasificación se describió en base a los hallazgos por TAC. Se presenta el caso de un paciente de 48 años con disección espontánea de la AMS.(AU)

Spontaneous dissection of the superior mesenteric artery is described as a tear or rupture of the intima and the inner layers of the stocking, allowing the passage of blood creating a false light in the middle layer. The clinical diagnosis is established after the appearance of sudden abdominal pain in patients with cardiovascular risk factors and its management can be endovascular or by open surgery, depending on factors that we will mention. The classification was described based on the CT findings. We present the case of a 48-year-old patient with spontaneous AMS dissection.(AU)

The Polemic Diagnostic Role of TP53 Mutations in Liquid Biopsies from Breast, Colon and Lung Cancers.

Being minimally invasive and thus allowing repeated measures over time, liquid biopsies are taking over traditional solid biopsies in certain circumstances such as those for unreachable tumors, very early stages or treatment monitoring. However, regarding TP53 mutation status analysis, liquid biopsies have not yet substituted tissue samples, mainly due to the lack of concordance between the two types of biopsies. This needs to be examined in a study-dependent manner, taking into account the particular type of liquid biopsy analyzed, that is, circulating tumor cells (CTCs) or cell-free DNA (cfDNA), its involvement in the tumor biology and evolution and, finally, the technology used to analyze each biopsy type. Here, we review the main studies analyzing TP53 mutations in either CTCs or cfDNA in the three more prevalent solid tumors: breast, colon and lung cancers. We evaluate the correlation for mutation status between liquid biopsies and tumor tissue, suggesting possible sources of discrepancies, as well as evaluating the clinical utility of using liquid biopsies for the analysis of TP53 mutation status and the future actions that need to be undertaken to make liquid biopsy analysis a reality for the evaluation of TP53 mutations.

Dolor abdominal crónico secundario a schwannoma mesentérico / No disponible

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Chronic abdominal pain due to mesenteric schwannoma.

This is a clinical case of a 48-year-old patient with chronic abdominal pain in association with a mesenteric tumor of neurogenic strain. Intra-abdominal schwannomas are an infrequent entity, characterized by presenting a larval and paucisymptomatic clinic and may even be a casual finding. Malignant degeneration is uncommon. Surgical excision is the gold standard to achieve definitive healing.

Cáncer escamoso asentado sobre sinus pilonidal recurrente: la evolución de una patología benigna y frecuente a una causa de muerte infrecuente / Squamous cancer settled on recurrent pilonidal sinus: the evolution of a benign and frequent pathology to an infrequent cause of death

El sinus pilonidal es una patología frecuente cuya malignización es infrecuente aunque su pronóstico puede ser fatal. El objetivo de esta publicación es presentar un caso de un paciente intervenido en múltiples ocasiones de escisiones de sinus pilonidal con degeneración maligna del mismo y evolución fatal, con el fin de recalcar la importancia del examen anatomopatológico sistemático de todas las muestras de escisión quirúrgica. (AU)

The pilonidal sinus is a frequent pathology whose malignization is uncommon although its prognosis can be fatal. The objective of this publication is to present a case of a patient intervened on multiple occasions of pilonidal sinus excisions with malignant degeneration and fatal evolution, in order to emphasize the importance of the systematic pathological examination of all surgical excision samples. (AU)