History of pseudomyxoma peritonei from its origin to the first decades of the twenty-first century.

Pseudomyxoma peritonei (PMP) is a disease surrounded by misunderstanding and controversies. Knowledge about the etymology of pseudomyxoma is useful to remove the ambiguity around that term. The word pseudomyxoma derives from pseudomucin, a type of mucin. PMP was first described in a case of a woman alleged to have a ruptured pseudomucinous cystadenoma of the ovary, a term that has disappeared from today's classifications of cystic ovarian neoplasms. It is known today that in the majority of cases, the origin for PMP is an appendiceal neoplasm, often of low histological grade. Currently, ovarian tumors are wrongly being considered a significant recognized etiology of PMP. PMP classification continues to be under discussion, and experts' panels strive for consensus. Malignancy is also under discussion, and it is shown in this review that there is a long-standing historical reason for that. Surgery is the main tool in the treatment armamentarium for PMP, and the only therapy with potential curative option.

Adenocarcinoma de apéndice con extensión extraapendicular: Análisis clínico-quirúrgico e histológico de 27 casos / Adenocarcinoma of the appendix with extra-appendicular spread: Clinico-surgical and histologic analysis of 27 cases

Fundamento y objetivos: La neoplasia apendicular con extensión extraapendicular puede mostrarse con diferentes patrones clínicos, entre ellos el pseudomixoma peritoneal (PMP). Analizamos los resultados de una serie clínica tratada en nuestro centro. Material y métodos: Estudio retrospectivo de pacientes con carcinomatosis peritoneal apendicular (desde enero de 2012 hasta mayo de 2015). Resultados: Veintisiete pacientes consecutivos. Edad mediana 63 años (26-73), 14 varones. Índice de carcinomatosis peritoneal=16±8 (3-31). El origen tumoral supuesto preoperatoriamente fue el apéndice en 23, el ovario en 3 y urotelial en uno. Mortalidad postoperatoria 2 pacientes (7,4%). El 36% de los restantes presentó morbilidad. Morbilidad mayor (Clavien-Dindo grados 3 y 4) en 3 pacientes (12%). Conclusiones: Los adenocarcinomas mucinosos extraapendiculares pueden manifestarse como PMP con ascitis mucinosa, carcinomatosis nodular gelatinosa sin ascitis, carcinomatosis nodular o placas desmoplásicas sin masas/nódulos gelatinosos. La histología no se correlaciona con la forma de presentación. La sospecha preoperatoria de cáncer de ovario mucinoso en el contexto de carcinomatosis peritoneal obliga a descartar que se trate de metástasis ováricas apendiculares (AU)

Background and objectives: Appendiceal neoplasms with extra-appendiceal spread may show different clinical patterns with pseudomyxoma peritonei (PMP) being one of them. We analyse the results in a series of patients treated in our center. Material and methods: Retrospective study of patients operated on for appendiceal peritoneal carcinomatosis from January 2012 to May 2015. Results: Twenty-seven consecutive patients were included. Median age 63 years (26-73); 14 were men. Peritoneal carcinomatosis index=16±8 (3-31). The suspected preoperative origins were appendix in 23, ovary in 3 and urothelial in one. Postoperative mortality in 2 patients (7.4%). The remaining 36% presented morbidity. Major morbidity (Clavien-Dindo grades 3 and 4) occurred in 3 patients (12%). Conclusions: Mucinous adenocarcinomas with extra-appendiceal spread may present as PMP with mucinous ascites, jelly-nodular carcinomatosis without ascites, nodular or desmoplasic plates carcinomatosis without jelly mass/nodules. Histology is not correlated to clinical picture. Preoperative diagnosis of mucinous ovarian cancer in peritoneal carcinomatosis scenario may increase the doubt of their ovarian origin and force an appendiceal origin to be ruled out (AU)

Adenocarcinoma of the appendix with extra-appendicular spread: Clinico-surgical and histologic analysis of 27 cases. / Adenocarcinoma de apéndice con extensión extraapendicular: Análisis clínico-quirúrgico e histológico de 27 casos.

BACKGROUND AND OBJECTIVES: Appendiceal neoplasms with extra-appendiceal spread may show different clinical patterns with pseudomyxoma peritonei (PMP) being one of them. We analyse the results in a series of patients treated in our centre. MATERIAL AND METHODS: Retrospective study of patients operated on for appendiceal peritoneal carcinomatosis from January 2012 to May 2015. RESULTS: Twenty-seven consecutive patients were included. Median age 63 years (26-73); 14 were men. Peritoneal carcinomatosis index=16±8 (3-31). The suspected preoperative origins were appendix in 23, ovary in 3 and urothelial in one. Postoperative mortality in 2 patients (7.4%). The remaining 36% presented morbidity. Major morbidity (Clavien-Dindo grades 3 and 4) occurred in 3 patients (12%). CONCLUSIONS: Mucinous adenocarcinomas with extra-appendiceal spread may present as PMP with mucinous ascites, jelly-nodular carcinomatosis without ascites, nodular or desmoplasic plates carcinomatosis without jelly mass/nodules. Histology is not correlated to clinical picture. Preoperative diagnosis of mucinous ovarian cancer in peritoneal carcinomatosis scenario may increase the doubt of their ovarian origin and force an appendiceal origin to be ruled out.

Síndrome del ducto pancreático desconectado: transección completa del páncreas secundaria a pancreatitis aguda / Disconnected pancreatic duct syndrome: complete pancreas transection secondary to acute pancreatitis

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Respuesta del autor: Tratamiento del carcinoma de vesícula incidental / Author’s reply: Management of incidental gallbladder carcinoma

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Hiperplasia nodular focal hepática y embarazo / Focal nodular hyperplasia of the liver and pregnancy

La hiperplasia nodular focal coincidente con la gestación es una entidad que puede generar dudas y alarmas en cuanto al curso del embarazo. Su descripción en la literatura médica es muy escasa y son menos aún los datos en cuanto al curso del parto. Presentamos un caso de una gestante a quien se había diagnosticado previamente una lesión hepática y se realiza una revisión de las series existentes hasta el momento (AU)

Focal nodular hyperplasia of the liver in pregnancy may lead to doubts and in appropriate fears regarding the course of the pregnancy. There is ascarcity of literature addressing focal nodular hyperplasia during gestation, and there are even less data focused on delivery. We report the case of a pregnant woman previously diagnosed with an hepatic lesion and present a review of the literature (AU)

Invaginación intestinal en el adulto: presentación de un caso y revisión de la literatura médica española / Intestinal invagination in adults: Presentation of a case and a review of the Spanish literature

Introducción La invaginación intestinal en el adulto es una entidad infrecuente, a menudo manifestada con síntomas inespecíficos crónicos o subagudos. En la mayoría de las ocasiones asocia una lesión orgánica. Actualmente no hay publicaciones de series amplias de pacientes que ayuden a definir el tratamiento de estos enfermos. Material y método Revisión de series de casos publicados en la literatura médica española. Se diseñó una base de datos de pacientes mayores de 15 años. Los datos se extrajeron de casos clínicos nacionales y se utilizaron recursos de Internet. Se añadió un caso clínico propio reciente. Resultados Se obtuvo una serie de 30 adultos con invaginación intestinal (29 de la revisión de casos y uno propio). La mediana de edad fue de 45 años (de 19 a 84); 17/30 (57%) fueron hombres. Presentaron dolor abdominal 27 pacientes y obstrucción intestinal establecida 8 casos (28%). El diagnóstico preoperatorio de invaginación se hizo en 25/30 pacientes (83%). Las invaginaciones fueron enteroentéricas (61%); colocólicas (12%); enterocólicas (21%), y yeyunogástricas (6%). El 85% de las invaginaciones asoció una lesión proliferativa y el 43% de estas últimas fueron malignas. Conclusiones Habitualmente el diagnóstico de invaginación en el adulto se obtiene preoperatoriamente. No hay datos para apoyar la resección intestinal sin realizar reducción. La resección debe ser la norma, y la presencia de adenopatías no es un argumento para realizar resecciones amplias (AU)

Introduction Intestinal invagination in the adult is an uncommon condition, often manifested by non-specific chronic or sub-acute symptoms. In the majority of occasions there is an organic lesion. There are currently no large patient series published in the literature to help define the management of these patients. Material and method A review of case series published in the Spanish literature. A data base of patients over 15 years old was designed. Data was extracted from national clinical cases using Internet resources. Our own recent clinical case is added. Results A series of 30 adults with intestinal invagination was obtained (29 cases from the review and one own). The median age was 45 years (19–84 years) and 17/30 (57%) were males. A total of 27/30 patients had abdominal pain and 8/30 (28%) cases had established intestinal obstruction. The preoperative diagnosis of invagination was made in 25/30 (83%) of patients. The invaginations were; enteroenteric, 61%; colocolic, 12%; enterocolic, 21%; and gastrojejunal, 6%. A total of 85% of the invaginations were associated with a proliferative lesion and 43% of the latter were malignant. Conclusions The diagnosis of invagination in the adult is usually made preoperatively. There are no data to support intestinal resection without performing a reduction. Resection must be the norm and the presence of lymph nodes is no argument to perform large resections (AU)

[Intestinal invagination in adults: Presentation of a case and a review of the Spanish literature]. / Invaginación intestinal en el adulto: presentación de un caso y revisión de la literatura médica española.

INTRODUCTION: Intestinal invagination in the adult is an uncommon condition, often manifested by non-specific chronic or sub-acute symptoms. In the majority of occasions there is an organic lesion. There are currently no large patient series published in the literature to help define the management of these patients. MATERIAL AND METHOD: A review of case series published in the Spanish literature. A data base of patients over 15 years old was designed. Data was extracted from national clinical cases using Internet resources. Our own recent clinical case is added. RESULTS: A series of 30 adults with intestinal invagination was obtained (29 cases from the review and one own). The median age was 45 years (19-84 years) and 17/30 (57%) were males. A total of 27/30 patients had abdominal pain and 8/30 (28%) cases had established intestinal obstruction. The preoperative diagnosis of invagination was made in 25/30 (83%) of patients. The invaginations were; enteroenteric, 61%; colocolic, 12%; enterocolic, 21%; and gastrojejunal, 6%. A total of 85% of the invaginations were associated with a proliferative lesion and 43% of the latter were malignant. CONCLUSIONS: The diagnosis of invagination in the adult is usually made preoperatively. There are no data to support intestinal resection without performing a reduction. Resection must be the norm and the presence of lymph nodes is no argument to perform large resections.

[Decrease of serum cholinesterase in colorectal cancer]. / Disminución de la colinesterasa sérica en el cáncer colorrectal.

BACKGROUND AND OBJECTIVE: Cholinesterase is an enzyme with an unknown physiologic function. Some situations are related to a decreased serum cholinesterase activity but those situations are not well defined and the responsible mechanisms are unknown. Malignancy is one of these situations. The aim of the study was to compare the cholinesterase activity between patients with and without colorectal cancer. PATIENTS AND METHOD: Case-control study of patients with colorectal cancer who underwent surgery in our hospital from March 05 to January 07. RESULTS: Patients from the cancer group had a significant decreased serum cholinesterase activity. CONCLUSIONS: Investigation of cholinesterase function in humans may result in new research lines in oncology treatment.

Disminución de la colinesterasa sérica en el cáncer colorrectal / Decrease of serum cholinesterase in colorectal cancer

Fundamento y objetivo: La colinesterasa es una enzima cuya función fisiológica se ignora. Hay diversas situaciones donde su actividad disminuye, pero aún no están bien definidas y se desconocen los mecanismos responsables. Una de estas situaciones es la presencia de malignidad. El objetivo de este estudio ha sido comparar la actividad de la colinesterasa en pacientes con y sin cáncer colorrectal. Pacientes y método: Se ha realizado un estudio de casos y controles, en el que se ha incluido a pacientes operados de carcinoma colorrectal en nuestro servicio entre marzo de 2005 y enero de 2007. Resultados: El grupo de cáncer presentó una disminución significativa de los valores séricos de actividad de colinesterasa. Conclusiones: El estudio de la función de la colinesterasa en el organismo humano puede ser útil en la génesis de nuevas líneas de investigación en tratamiento oncológico

Background and objective: Cholinesterase is an enzyme with an unknown physiologic function. Some situations are related to a decreased serum cholinesterase activity but those situations are not well defined and the responsible mechanisms are unknown. Malignancy is one of these situations. The aim of the study was to compare the cholinesterase activity between patients with and without colorectal cancer. Patients and method: Case-control study of patients with colorectal cancer who underwent surgery in our hospital from March 05 to January 07. Results: Patients from the cancer group had a significant decreased serum cholinesterase activity. Conclusions: Investigation of cholinesterase function in humans may result in new research lines in oncology treatment