Variaciones de la configuración ductal pancreática: factor predisponente de pancreatitis recurrente / Variations of pancreatic ductal configuration: predisposing factor of recurrent pancreatitis

El páncreas es un órgano de origen endodérmico, que se desarrolla de dos esbozos intestinales separados, uno dorsal y otro ventral,a partir de la cuarta o quinta semana de gestación. El páncreas se origina en el intestino anterior en la parte correspondiente a lafutura segunda porción duodenal. Allí se originan dos brotes: uno posterior o dorsal que aparece a principios de la cuarta semanay crece rápidamente en el mesenterio dorsal y el otro brote es anterior o ventral. Este último da origen a dos brotes, uno origina unaparte del páncreas y otro a la vía biliar e hígado. Existen diferentes variantes anatómicas, derivadas de este desarrollo embrionario;su conocimiento es de vital importancia en pacientes con persistencia de dolor abdominal y episodios de pancreatitis recurrente.El objetivo de este artículo es una revisión de las variantes anatómicas del conducto pancreático que pueden manifestarse como pancreatitis idiopática recurrente. (AU)

The pancreas is an organ of endodermal origin, which develops from two separate intestinal sketches, one dorsal and one ventral,from the fourth or fifth week of gestation. The pancreas originates in the anterior intestine in the part corresponding to the futuresecond duodenal portion. There two shoots originate: one posterior or dorsal that appears at the beginning of the fourth week andgrows rapidly in the dorsal mesentery and the other outbreak is anterior or ventral. The latter gives rise to two outbreaks, oneoriginates a part of the pancreas and another to the bile duct and liver. There are different anatomical variants, derived from thisembryonic development; their knowledge is of vital importance in patients with persistent abdominal pain and episodes of recurrentpancreatitis. The objective of this article is a review of the anatomical variants of the pancreatic duct that can manifest as recurrent idiopathic pancreatitis. (AU)

Unusual relationship between skin lesions and esophageal cancer: a case report and review of literature.

Esophageal cancer is a rare disease. In Spain, this tumor is the third most common gastrointestinal malignancy after colorectal and gastric cancer. Esophageal adenocarcinoma metastasizes to the skin with an incidence of 1 %, generally located in the neck, head and abdomen. It usually occurs in the overlying skin of the primary tumor, but may also appear in a distant site, the scalp being the most common place. Although the pathogenesis of esophageal adenocarcinoma is not well known, the existence of genetic alterations, such as the suppressor gene, has been proved and the involvement of oncogene c-erbB-2 amplified. Cytokeratin 20 and 7 are expressed in esophageal adenocarcinoma. Typically, cutaneous metastases from internal malignancy present as firm asymptomatic nodules. These nodules usually occur in multiple arrays on the skin adjacent to the primary tumor; however, they can occasionally become painful spontaneously. The main diagnostic test of esophageal cancer is the upper endoscopy, along with histopathology for confirmation of the tumor. The developments in surgery and the discovery of new cytotoxic agents have considerably decreased the locoregional recurrence. To date, the combination of these treatment modalities for advanced adenocarcinoma revealed that the recurrences mainly occur from hematic spread. Excision of the skin lesions produces pain palliation. In patients diagnosed with esophageal cancer who have responded satisfactorily to treatment with chemotherapy, radiation and surgery while having a long history of remission, and dermatology outpatient visits by the appearance of skin lesions, should make us think among the different differential diagnoses, the possibility of cutaneous metastases.