Carcinoma nasofaríngeo: conducta del médico internista ante un caso de adenopatía cervical con sospecha de malignidad / Nasopharyngeal carcinoma: behavior of internist facing a case of cervical lymphadenopathy with suspected malignancy

Resumen El carcinoma nasofaríngeo es un tumor de células escamosas que comúnmente aparece alrededor del ostium de la trompa de Eustaquio en la pared lateral de la nasofaringe. En términos generales, es una causa rara de cáncer en el mundo, aunque llega a ser muy frecuente en países del sureste de Asia y en Alaska. En México, el carcinoma nasofaríngeo no figura entre las 20 principales causas de cáncer. Esta neoplasia se ha relacionado con el virus Epstein-Barr, pero en su aparición también intervienen factores genéticos, raciales, ambientales y dietéticos. Los síntomas iniciales son inespecíficos, por lo que el paciente y el médico de primer contacto los pasan por alto. La manifestación sintomática más común es la linfadenopatía cervical, que puede ser bilateral y voluminosa incluso en 50% de los afectados. Se comunica el caso de un paciente de 70 años de edad con diagnóstico de carcinoma nasofaríngeo, que acudió al servicio de medicina interna por adenopatía cervical bilateral, y cuyo diagnóstico final requirió un enfoque multidisciplinario.

Abstract Nasopharyngeal carcinoma (NPC) is a squamous cell tumor that usually develops around the lateral wall of the nasopharynx near the Eustachian tube ostium. Overall it is a rare cause of cancer worldwide, although it has a high frequency in some endemic regions of Southeast Asia and Alaska. In Mexico, nasopharyngeal carcinoma is not listed among the 20 leading causes of cancer in the country. The etiology of NPC has been linked mainly to Epstein-Barr virus (EBV), but also involves genetic, racial, environmental and dietary risk factors. The clinical presentation is non-specific and this can be misleading to the primary care physician. The most common symptomatic presentation is cervical lymphadenopathy, which can be bilateral and voluminous up to 50% of patients. This paper reports the case of a 70 year-old man diagnosed with NPC, who was admitted in the internal medicine ward because of bilateral cervical lymphadenopathy, and a multidisciplinary approach was required to establish the final diagnosis.

Sling left pulmonary artery, bridging bronchus, and associated anomalies.

Sling left pulmonary artery (SLPA) is often associated with tracheobronchial abnormalities, including bridging bronchus (BB). We report on 3 patients with SLPA: One patient had a narrow trachea, absent right upper lobe and right main bronchus, and BB. The second patient had a long and narrow trachea, with normal segmentation of bronchial tree, abnormal cerebral gyri, and minor facial abnormalities. The third patient, with a normal trachea and main bronchi with BB, had imperforate anus, hemivertebrae, and atrial septal defect (VATER association). Patients with SLPA, those with BB, or those with both SLPA and BB as well as multiple congenital anomalies represent a spectrum of anomalies.

[The VATER association]. / Asociación VATER.

The clinical, radiologic, and anatomic features of 53 patients with VATER association were reviewed. The vertebral, anorrectal, tracheoesophageal, radial, and renal congenital defects included in the association are similar to those described by other authors. In this report genital anomalies are very frequent and should be included as a diagnostic criteria for this association. Encephalic, facial, and cranial congenital defects are common and can affect prognosis; 17 patients have other malformations patterns, and they can belong to a different group of malformations.

[Peptic acid disease associated with Helicobacter pylori in children. Report of a case]. / Enfermedad ácido péptica asociada a Helicobacter pylori en niños. Reporte de un caso.

We studied a child with peptic acid disease which was associated with H. pylori. The identification of H. pylori was done by biopsy and for antibody test. Clinical improvement was observed only with the use of amoxocilin and Bismuth subsalycilate.

Bulky naevocytoma of the perineum: a singular variant of congenital giant pigmented naevus.

We describe two instances of a previously unrecognized variant of congenital giant pigmented naevus (GPN), presenting as a bulky naevocytic tumour in the perineal region. In both cases the lesion was present at birth and attained massive dimensions. In addition to the characteristic histological patterns found in GPN, which included extensive areas with a neural appearance, these tumours presented an uncommon tendency to form pseudo-follicular structures lined by naevus cells. No features suggestive of malignant transformation were found. Because GPN may associate with an underlying malignancy, accurate diagnosis of this lesion is important in clinical practice.

Ectopia cordis: autopsy findings in four cases.

Ectopia cordis (EC) is a rare congenital malformation characterized by the abnormal position of the heart outside the thorax. Since it is often associated with intracardiac anomalies, an adequate surgical approach requires a precise knowledge of the intra- and extracardiac morbid anatomy. We report 4 cases of EC with a detailed description of intracardiac findings at autopsy. The associated malformations were severe and aggravated the outcome. Intracardiac anomalies are sometimes mild, but can be associated with a severe extracardiac defect.