Hidradenitis supurativa con transformación carcinomatosa / Suppurative hidradenitis with carcinomatous transformation

La Hidradenitis Supurativa o Enfermedad de Verneuil es un proceso inflamatorio crónico, recurrente que afecta las glándulas apócrinas de axila, ingle, periné, cuero cabelludo y región anoperineal. Se desconoce la etiología precisa. Es una enfermedad poco frecuente, mal diagnosticada, se estima la incidencia en 1 cada 300 adultos. Afecta más a mujeres y personas de raza negra, sin embargo la enfermedad de localización perianal afecta más a varones. El tratamiento médico mitigaría los síntomas pero la mayoría de los pacientes presentan lesiones crónicas que requerirán tratamiento quirúrgico. El Carcinoma de Células Escamosas es una complicación rara vez informada que se desarrolla en las lesiones crónicas de Hidradenitis Supurativa de larga evolución. Presentamos un caso de un paciente de sexo masculino, de 51 años de edad, que presenta sobre antiguas lesiones cicatrizales formación tumoral multilobulada, ulcerada centralmente localizada en región glútea-perineal izquierda de 3 meses de evolución. Se realizaron métodos complementarios arribando al diagnóstico de Hidradenitis Supurativa con Transformación Carcinomatosa (Carcinoma de Células Escamosas). Se realizó tratamiento quirúrgico con posterior injerto cutáneo con excelente evolución. Motiva ésta presentación la localización infrecuente y la complicación inusual. Como dato relevante cabe destacar las escasas publicaciones sobre dicho tema (AU)

Hidradenitis Suppurativa or Verneuil's disease is a chronic inflammatory recurring process that affects the apocrine glands of the armpit, groin, perineal area, scalp and an operineal area. Its accurate ethiology is unknown. It is a rare disease, it is misdiagnosed and its incidence rate is estimated in 1 every 300 adults. It affects mainly women and black race people. However the perianal localization disease affects mainly men. The medical treatment would mitigate the symptoms but most patients have chronic lesions that would require surgical treatment. The squamous cell carcinoma is a rarely reported complication which develops in the chronic lesions of Hidradenitis Suppurativa of long-term evolution. We present a case of a male patient, 51 years old, who has, on old scar lesions, a centrally ulcerated multilobulated tumor formation of 3 months of evolution localized in the left gluteo-perineal area. Complementary methods were used which led to the diagnostics of Hydradernitis Suppurativa with Carcinomatose Transformation (Squamous cellcarcinoma). Surgical treatment followed by skin graft was used with excellent evolution. The reason for this presentation is the infrequent localization and the unusual complication. Something important to point out is that publications on this topic are rare (AU)

Carcinoma epidermoide de vesícula: análisis de nuestra casuística / Epidermoid carcinoma of gallbladder: analysis of our casuistic

BACKGROUND: The most common type of gallbladder cancer is the adenocarcinoma. The squamous cell carcinoma represents only a 0-12% of all gallbladder tumors. METHODS: 124 cases of malignant neoplasias of the gallbladder were diagnosed during the last 33 years in the Department of Surgery of our hospital. From these cases, 5 were squamous cell carcinomas, representing 2.41% of our series. CASE REPORT: The ratio female: male was 1.5:1, and the mean age was 50.2 years. Liver involvement was observed in 4 of 5 patients at the moment of diagnosis. Four patients underwent surgery and one received palliative treatment with percutaneous bile dreinage. The mean survival was 14.5 months. CONCLUSION: The tumor extention at the time of diagnosis is generally advanced and the outcome is not promising in this kind of gallbladder cancer.

Antecedentes: El tumor maligno de vesícula más frecuente es el adenocarcinoma. El carcinoma epidermoide representa solamente el 0-12% de todos ellos. Métodos: Se analizaron retrospectivamente 124 casos de neoplasias malignas de vesícula biliar diagnosticadosen los últimos 33 años en nuestro Servicio de Cirugía. Cinco resultaron ser carcinomas epidermoides,lo que representa un 2.41%. Casos: La relación mujer: varón fue de 1.5:1, y la edad media de presentación, 50.2 años. El compromiso hepático se observó en4 de los 5 pacientes en el momento del diagnóstico. Cuatro pacientes fueron sometidos a cirugía y un pacientea tratamiento paliativo con drenaje biliar percutáneo. La sobrevida media fue de 14.5 meses. Conclusión: La extensión tumoral en el momento deldiagnóstico es, en general, avanzada, por lo que el pronóstico en esta estirpe de cáncer de vesícula no es promisorio.

Carcinoma epidermoide de vesícula: análisis de nuestra casuística / Epidermoid carcinoma of gallbladder: analysis of our casuistic

BACKGROUND: The most common type of gallbladder cancer is the adenocarcinoma. The squamous cell carcinoma represents only a 0-12% of all gallbladder tumors. METHODS: 124 cases of malignant neoplasias of the gallbladder were diagnosed during the last 33 years in the Department of Surgery of our hospital. From these cases, 5 were squamous cell carcinomas, representing 2.41% of our series. CASE REPORT: The ratio female: male was 1.5:1, and the mean age was 50.2 years. Liver involvement was observed in 4 of 5 patients at the moment of diagnosis. Four patients underwent surgery and one received palliative treatment with percutaneous bile dreinage. The mean survival was 14.5 months. CONCLUSION: The tumor extention at the time of diagnosis is generally advanced and the outcome is not promising in this kind of gallbladder cancer.(AU)

Antecedentes: El tumor maligno de vesícula más frecuente es el adenocarcinoma. El carcinoma epidermoide representa solamente el 0-12% de todos ellos. Métodos: Se analizaron retrospectivamente 124 casos de neoplasias malignas de vesícula biliar diagnosticadosen los últimos 33 años en nuestro Servicio de Cirugía. Cinco resultaron ser carcinomas epidermoides,lo que representa un 2.41%. Casos: La relación mujer: varón fue de 1.5:1, y la edad media de presentación, 50.2 años. El compromiso hepático se observó en4 de los 5 pacientes en el momento del diagnóstico. Cuatro pacientes fueron sometidos a cirugía y un pacientea tratamiento paliativo con drenaje biliar percutáneo. La sobrevida media fue de 14.5 meses. Conclusión: La extensión tumoral en el momento deldiagnóstico es, en general, avanzada, por lo que el pronóstico en esta estirpe de cáncer de vesícula no es promisorio.(AU)

Parathyroidectomy for parathyroid carcinoma in renal transplantation.

INTRODUCTION: Hyperparathyroidism (HPT) is a highly prevalent pathology in the chronic renal disease population, which is associated with considerable morbidity, and mortality. The histopathological findings most often reported are solitary adenoma, diffuse hyperplasia, and autonomous hyperplasia. Carcinoma is an unusual cause of primary parathyroid hyperfunction (0.5% to 4% according to data); in renal transplanted patients it is exceptional. We sought to analyze parathyroid gland histology from renal transplant patients in comparison with nontransplanted patients and to report a parathyroid carcinoma case in a renal transplant patient. METHODS: We retrospectively analyzed parathyroidectomies (PTX) and histopathological reports between March 1989 and December 2003. RESULTS: Among 72 PTXs 41 were performed because of primary HPT; 26, secondary HPT; and five, tertiary HPT. Among the 41 primary HPT cases there were two carcinomas (4.88% primary HPT operated patients), one of whom was in a kidney transplant recipient. Among the total number of surgeries, seven were performed in six renal transplant patients, including five diffuse hyperplasia cases; one, nodular hyperplasia with an adenoma focus; and one, parathyroid carcinoma. CONCLUSIONS: Parathyroidectomy indications in the renal transplant population are usually associated with the clinical picture of tertiary HPT, which does not resolve after a functional renal transplant. In spite of this, diffuse hyperplasia, which is associated with secondary HPT, was the most frequent hystological finding. Two carcinomas were observed: one in a renal transplant patient (16.6% parathyroidectomies) and the other in a patient who did not show renal failure. These data coincide with international records.

Tumores estromales gastrointestinales / Stromal tumors gastrointestinal

Introducción: los tumores estromales gastrointestinales (GISTs)son un grupo eterogéneo de neoplasias mesenquimáticas, controvertidas para muchos en cuanto a morfología, criterios diagnósticos y comportamiento. Datos clínicos: se revisaron todos los tumores mesenquimáticos gastrointestinales de archivo del período 1992-2002. Se hallaron 7 casos de GISTs (25 por ciento de los tumores mesenquimáticos): 4 mujeres y 3 hombres, de 53 a 89 años; 5 fueron de estámago, 1 de intestino delgado y 1 de trascavidad de los epiplones. Métodos disgnósticos: el material se procesó según técnicas de rutina y se coloreó con H.E. Se efectuó IHQ para Actina Músculo Liso (AML), Desmina, S 100, CD 117. Hallazgo macroscópicos: todos los casos correspondieron a piezas quirúrgicas (gastrectomía, resección segmentaria intestinal o tumorectomía). El tamaño tumoral osciló entre 4 y 25 cm. Hallazgos microscópicos: consistieron en proliferaciones fusiformes, con grado variable de celularidad, atipía y actividad mitótica (AM)...

Tumores estromales gastrointestinales / Stromal tumors gastrointestinal

Introducción: los tumores estromales gastrointestinales (GISTs)son un grupo eterogéneo de neoplasias mesenquimáticas, controvertidas para muchos en cuanto a morfología, criterios diagnósticos y comportamiento. Datos clínicos: se revisaron todos los tumores mesenquimáticos gastrointestinales de archivo del período 1992-2002. Se hallaron 7 casos de GISTs (25 por ciento de los tumores mesenquimáticos): 4 mujeres y 3 hombres, de 53 a 89 años; 5 fueron de estámago, 1 de intestino delgado y 1 de trascavidad de los epiplones. Métodos disgnósticos: el material se procesó según técnicas de rutina y se coloreó con H.E. Se efectuó IHQ para Actina Músculo Liso (AML), Desmina, S 100, CD 117. Hallazgo macroscópicos: todos los casos correspondieron a piezas quirúrgicas (gastrectomía, resección segmentaria intestinal o tumorectomía). El tamaño tumoral osciló entre 4 y 25 cm. Hallazgos microscópicos: consistieron en proliferaciones fusiformes, con grado variable de celularidad, atipía y actividad mitótica (AM)...(AU)

[Granular cell tumor of the esophagus. Morphological and immunohistochemical study]. / Tumor de células granulares del esófago. Estudio morfológico e inmunohistoquímico.

Granular cell tumor or Abrikosoff's tumor is an infrequent and usually benign neoplasm which is found predominantly in the head and neck region, especially in the tongue. Its esophageal location is unusual, where most of them present as small, well circumscribed lesions which follow a benign course. Because of its low incidence in this site (less than 200 cases having been reported until 1993), we report two cases of esophageal granular cell tumors, both of them in male patients. CASE 1: A 34 year old patient who presented with epigastralgia, heartburn and abdominal distention. He was treated endoscopically because he had a firm new growth in the lower third of the esophagus measuring 1 cm in diameter. CASE 2: A 50 year old patient who presented with digestive tract haemorrhage (hematemesis and melena) 5 cm above the cardias a submucosal polyp was found of 0.8 cm in its largest diameter. MICROSCOPY: Both cases showed a subepithelially located new growth, composed of polygonal cells with eosinophilic granular cytoplasm, small rounded nuclei, and conspicuous intracytoplasmatic positivity for S100 protein. With these elements we reached the diagnosis of granular cell tumor. The bibliography is reviewed and an update is made of its histopathologic characteristics in addition to histogenetic and clinical considerations.

[Activation of K-ras and c-erbB-2 protooncogenes in human colonic adenocarcinomas]. / Activación de los protooncogenes K-ras y c-erbB-2 en adenocarcinomas colónicos humanos.

Although data on genetic alterations leading to development of colorectal cancer are abundant, no specific genetic alteration has been demonstrated for each class of tumor. The colorectal cancer phenotype is originated from an accumulation of different genetic alterations. The nature of these alterations, their order of appearance, and their associations vary greatly from one tumor to another, suggesting that the concept of a unique model of carcinogenesis is not applicable to these tumors. The aim of the present work was to study the association between K-ras and c-erbB-2 mutations and different clinicopathological variables in fifty-four samples from adenocarcinomas of the colon. The detection of K-ras activation was performed by specific enriched PCR. The genomic differential polymerase chain reaction with the single copy reference gene was employed for the detection of c-erbB-2 gene amplification. K-ras mutations were detected in 16 cases (29.63%) and c-erbB-2 amplifications in 1 sample (1.85%). Statistical analysis showed a significant association between K-ras codon 12 mutation frequency and Duke's stage B (p < 0.05). On the other hand, there was no association in relation to the other studied parameters. These results could indicate the occurrence of K-ras activation in early stages of the disease.

[Cystic duplication of the esophagus]. / Duplicación quística del esófago.

UNLABELLED: Duplication is defined as the presence of a complete or partial double structure, with a variable length. In esophagus, duplications, diverticuli and cysts might be manifestations of the same embriologic defect. The most common is the Cystic Duplication of the esophagus (CDE), which represents the esophageal duplication, either spherical or tubular, with squamous or columnar epithelium, and a double muscular layer. CLINICAL CASE: male, 38 years old with no previous relevant data, and sudden, complete and persistent post ingestion aphagia, intense presternal pain, and a 12 Kg. weight loss in 15 days. Endoscopy showed unsurpassable stenosis of the lower third of the esophagus, with normal mucosa. Total esophagectomy and replacement with a gastric tube, was performed. He had a good postoperative course. PATHOLOGY: A total esophagectomy open specimen showing a cystic structure at the posterior wall was submitted, which showed a thick, muscular-like wall and hemorrhagic internal surface. Microscopically it had a pseudostratified columnar, ciliated epithelium, alternating with sloughed hemorrhagic areas, fibrosis and stromal siderophagi Leiomuscular double-layered wall. CDE is very infrequent, and is the second most frequent after leiomiomas as a benign esophageal mass. From 10 to 15% of all digestive duplications take place at the esophagus. There are different theories to explain its origin. Differential diagnosis must be made mainly with brochogenic cyst, generally anterior and with cartilage. Treatment is surgical.

Duplicación quística del esófago / Cystic duplication of the esophagus

Duplication is defined as the presence of a complete or partial double structure, with a variable length. In esophagus, duplications, diverticuli and cysts might be manifestations of the same embriologic defect. The most common is the Cystic Duplication of the esophagus (CDE), which represents the esophageal duplication, either spherical or tubular, with squamous or columnar epithelium, and a double muscular layer. Clinical Case: male, 38 years old with no previous relevant data, and sudden, complete and persistent post ingestion aphagia, intense presternal pain, and a 12 Kg. weight loss in 15 days. Endoscopy showed unsurpassable stenosis of the lower third of the esophagus, with normal mucosa. Total esophagectomy and replacement with a gastric tube, was performed. He had a good postoperative course. PATHOLOGY: A total esophagectomy open specimen showing a cystic structure at the posterior wall was submitted, which showed a thick, muscular-like wall and hemorrhagic internal surface. Microscopically it had a pseudostratified columnar, ciliated epithelium, alternating with sloughed hemorrhagic areas, fibrosis and stromal siderophagi Leiomuscular double-layered wall. CDE is very infrequent, and is the second most frequent after leiomiomas as a benign esophageal mass. From 10 to 15 percent of all digestive duplications take place at the esophagus. There are different theories to explain its origin. Differential diagnosis must be made mainly with brochogenic cyst, generally anterior and with cartilage. Treatment is surgical.

Activación de los protooncogenes K-ras y c-erbB-2 en adenocarcinomas colónicos humanos / Activation of K-ras and c-erbB-2 protooncogenes in human colonic adenocarcinomas

Aunque los datos de las alteraciones genéticas que conducen al desarrollo de cáncer colorectal son abundantes, las alteraciones genéticas específicas para cada clase de tumor no han sido demostradas. El fenotipo cáncer colorectal es originado por la acumulación de diferentes alteraciones genéticas. La naturaleza de esas alteraciones, su orden de aparición y sus asociaciones, varian ampliamente de un tumor a otro, sugiriendo que el concepto de un modelo único de carcinogénesis no es aplicable a estos tumores. El objetivo del presente trabajo fue estudiar la asociación entre las mutaciones en los protooncogenes K-ras y c-erbB-2 con diferentes variables clinicopatológicas en 54 muestras de adenocarcinomas de colon. La detección de la activación de K-ras en 16 casos fue hecha mediante PCR alelo específica. Para la detección de la amplificación genética en c-erbB-2 se empleó un método de coamplificación por PCR con gen de copia única como referencia. Fueron detectadas mutaciones en K-ras en 16 casos (29,63 por ciento) y amplificación en c-erbB-2 en una muestra (1,85 por ciento). El análisis estadístico mostró una asociación significativa entre frecuencia de mutaciones en el codón 12 de K-ras y el estadio B de Dukes (p<0.005). Por otra parte, no se encontró asociación alguna con los otros parámetros estudiados. Estos resultados indicarian que la activación del protooncogén K-ras podría ocurrir en estadíos tempranos de la enfermedad. (Au)

Duplicación quística del esófago / Cystic duplication of the esophagus

Duplication is defined as the presence of a complete or partial double structure, with a variable length. In esophagus, duplications, diverticuli and cysts might be manifestations of the same embriologic defect. The most common is the Cystic Duplication of the esophagus (CDE), which represents the esophageal duplication, either spherical or tubular, with squamous or columnar epithelium, and a double muscular layer. Clinical Case: male, 38 years old with no previous relevant data, and sudden, complete and persistent post ingestion aphagia, intense presternal pain, and a 12 Kg. weight loss in 15 days. Endoscopy showed unsurpassable stenosis of the lower third of the esophagus, with normal mucosa. Total esophagectomy and replacement with a gastric tube, was performed. He had a good postoperative course. PATHOLOGY: A total esophagectomy open specimen showing a cystic structure at the posterior wall was submitted, which showed a thick, muscular-like wall and hemorrhagic internal surface. Microscopically it had a pseudostratified columnar, ciliated epithelium, alternating with sloughed hemorrhagic areas, fibrosis and stromal siderophagi Leiomuscular double-layered wall. CDE is very infrequent, and is the second most frequent after leiomiomas as a benign esophageal mass. From 10 to 15 percent of all digestive duplications take place at the esophagus. There are different theories to explain its origin. Differential diagnosis must be made mainly with brochogenic cyst, generally anterior and with cartilage. Treatment is surgical. (Au)

Activación de los protooncogenes K-ras y c-erbB-2 en adenocarcinomas colónicos humanos. / [Activation of K-ras and c-erbB-2 protooncogenes in human colonic adenocarcinomas]

Although data on genetic alterations leading to development of colorectal cancer are abundant, no specific genetic alteration has been demonstrated for each class of tumor. The colorectal cancer phenotype is originated from an accumulation of different genetic alterations. The nature of these alterations, their order of appearance, and their associations vary greatly from one tumor to another, suggesting that the concept of a unique model of carcinogenesis is not applicable to these tumors. The aim of the present work was to study the association between K-ras and c-erbB-2 mutations and different clinicopathological variables in fifty-four samples from adenocarcinomas of the colon. The detection of K-ras activation was performed by specific enriched PCR. The genomic differential polymerase chain reaction with the single copy reference gene was employed for the detection of c-erbB-2 gene amplification. K-ras mutations were detected in 16 cases (29.63

) and c-erbB-2 amplifications in 1 sample (1.85

). Statistical analysis showed a significant association between K-ras codon 12 mutation frequency and Dukes stage B (p < 0.05). On the other hand, there was no association in relation to the other studied parameters. These results could indicate the occurrence of K-ras activation in early stages of the disease.

Tumor de células granulares del esófago. Estudio morfológico e inmunohistoquímico. / [Granular cell tumor of the esophagus. Morphological and immunohistochemical study]

Granular cell tumor or Abrikosoffs tumor is an infrequent and usually benign neoplasm which is found predominantly in the head and neck region, especially in the tongue. Its esophageal location is unusual, where most of them present as small, well circumscribed lesions which follow a benign course. Because of its low incidence in this site (less than 200 cases having been reported until 1993), we report two cases of esophageal granular cell tumors, both of them in male patients. CASE 1: A 34 year old patient who presented with epigastralgia, heartburn and abdominal distention. He was treated endoscopically because he had a firm new growth in the lower third of the esophagus measuring 1 cm in diameter. CASE 2: A 50 year old patient who presented with digestive tract haemorrhage (hematemesis and melena) 5 cm above the cardias a submucosal polyp was found of 0.8 cm in its largest diameter. MICROSCOPY: Both cases showed a subepithelially located new growth, composed of polygonal cells with eosinophilic granular cytoplasm, small rounded nuclei, and conspicuous intracytoplasmatic positivity for S100 protein. With these elements we reached the diagnosis of granular cell tumor. The bibliography is reviewed and an update is made of its histopathologic characteristics in addition to histogenetic and clinical considerations.

Duplicación quística del esófago. / [Cystic duplication of the esophagus]

Duplication is defined as the presence of a complete or partial double structure, with a variable length. In esophagus, duplications, diverticuli and cysts might be manifestations of the same embriologic defect. The most common is the Cystic Duplication of the esophagus (CDE), which represents the esophageal duplication, either spherical or tubular, with squamous or columnar epithelium, and a double muscular layer. Clinical Case: male, 38 years old with no previous relevant data, and sudden, complete and persistent post ingestion aphagia, intense presternal pain, and a 12 Kg. weight loss in 15 days. Endoscopy showed unsurpassable stenosis of the lower third of the esophagus, with normal mucosa. Total esophagectomy and replacement with a gastric tube, was performed. He had a good postoperative course. PATHOLOGY: A total esophagectomy open specimen showing a cystic structure at the posterior wall was submitted, which showed a thick, muscular-like wall and hemorrhagic internal surface. Microscopically it had a pseudostratified columnar, ciliated epithelium, alternating with sloughed hemorrhagic areas, fibrosis and stromal siderophagi Leiomuscular double-layered wall. CDE is very infrequent, and is the second most frequent after leiomiomas as a benign esophageal mass. From 10 to 15

of all digestive duplications take place at the esophagus. There are different theories to explain its origin. Differential diagnosis must be made mainly with brochogenic cyst, generally anterior and with cartilage. Treatment is surgical.

Activación de los protooncogenes K-ras y c-erbB-2 en adenocarcinomas colónicos humanos / Activation of K-ras and c-erbB-2 protooncogenes in human colonic adenocarcinomas

Aunque los datos de las alteraciones genéticas que conducen al desarrollo de cáncer colorectal son abundantes, las alteraciones genéticas específicas para cada clase de tumor no han sido demostradas. El fenotipo cáncer colorectal es originado por la acumulación de diferentes alteraciones genéticas. La naturaleza de esas alteraciones, su orden de aparición y sus asociaciones, varian ampliamente de un tumor a otro, sugiriendo que el concepto de un modelo único de carcinogénesis no es aplicable a estos tumores. El objetivo del presente trabajo fue estudiar la asociación entre las mutaciones en los protooncogenes K-ras y c-erbB-2 con diferentes variables clinicopatológicas en 54 muestras de adenocarcinomas de colon. La detección de la activación de K-ras en 16 casos fue hecha mediante PCR alelo específica. Para la detección de la amplificación genética en c-erbB-2 se empleó un método de coamplificación por PCR con gen de copia única como referencia. Fueron detectadas mutaciones en K-ras en 16 casos (29,63 por ciento) y amplificación en c-erbB-2 en una muestra (1,85 por ciento). El análisis estadístico mostró una asociación significativa entre frecuencia de mutaciones en el codón 12 de K-ras y el estadio B de Dukes (p<0.005). Por otra parte, no se encontró asociación alguna con los otros parámetros estudiados. Estos resultados indicarian que la activación del protooncogén K-ras podría ocurrir en estadíos tempranos de la enfermedad.

Estudio sistematico de piezas de gastrectomia por cancer en busqueda de carcinomas sincronicos / Systematic study of gastrectomy specimens for cancer, in search of synchronic carcinomas

Multiple carcinomas were searched in 50 successive gastrectomies, 17 females (34 percent) 33 males (66 percent) from 40 to 83 years old. Macroscopic handling of the specimens included pinning an a board, fresh, half-fixed and completely fixed examination, not only by naked eye but also through a magnifying glass. The stomach were totally studied, according to japanese method. A satisfactory slide was obtained from each block, stained with H.E. and examined by each of the authors. Synchronous tumors were found in 4 cases (8 percent), 3 males and one female. Compared to the main lesion, two cases showed a proximal tumor, one case showed a distal tumor, and the last one showed two tumors, one of them proximal and the other distal. Three tumors were macroscopically and two were microscopically detected. Two of them coexisted with advanced carcinoma and three with early carcinoma. Four of them were located in mucosa with intestinal metaplasia. Histologically, four cases belong to the same type of the original tumor, and one of them did not coincide. We conclude that stomachs resected for cancer must be thoroughly and methodically studied before and after fixation. We suggest that resection must include the whole mucosa with intestinal metaplasia, in order to avoid leaving a synchronous tumor in the gastric stump.

Estudio sistematico de piezas de gastrectomia por cancer en busqueda de carcinomas sincronicos / Systematic study of gastrectomy specimens for cancer, in search of synchronic carcinomas

Multiple carcinomas were searched in 50 successive gastrectomies, 17 females (34 percent) 33 males (66 percent) from 40 to 83 years old. Macroscopic handling of the specimens included pinning an a board, fresh, half-fixed and completely fixed examination, not only by naked eye but also through a magnifying glass. The stomach were totally studied, according to japanese method. A satisfactory slide was obtained from each block, stained with H.E. and examined by each of the authors. Synchronous tumors were found in 4 cases (8 percent), 3 males and one female. Compared to the main lesion, two cases showed a proximal tumor, one case showed a distal tumor, and the last one showed two tumors, one of them proximal and the other distal. Three tumors were macroscopically and two were microscopically detected. Two of them coexisted with advanced carcinoma and three with early carcinoma. Four of them were located in mucosa with intestinal metaplasia. Histologically, four cases belong to the same type of the original tumor, and one of them did not coincide. We conclude that stomachs resected for cancer must be thoroughly and methodically studied before and after fixation. We suggest that resection must include the whole mucosa with intestinal metaplasia, in order to avoid leaving a synchronous tumor in the gastric stump. (AU)

[Systematic study of gastrectomy specimens for cancer, in search of synchronous carcinomas]. / Estudio sistematico de piezas de gastrectomia por cáncer en búsqueda de carcinomas sincrónicos.

Multiple carcinomas were searched in 50 successive gastrectomies, 17 females (34%) 33 males (66%) from 40 to 83 years old. Macroscopic handling of the specimens included pinning on a board, fresh, half-fixed and completely fixed examination, not only by naked eye but also through a magnifying glass. The stomach were totally studied, according to Japanese method. A satisfactory slide was obtained from each block, stained with H.E. and examined by each of the authors. Synchronous tumors were found in 4 cases (8%), 3 males and one female. Compared to the main lesion, two cases showed a proximal tumor, one case showed a distal tumor, and the last one showed two tumors, one of them proximal and the other distal. Three tumors were macroscopically and two were microscopically detected. Two of them coexisted with advanced carcinoma and three with early carcinoma. Four of them were located in mucosa with intestinal metaplasia. Histologically, four cases belong to the same type of the original tumor, and one of them did not coincide. We conclude that stomachs resected for cancer must be thoroughly and methodically studied before and after fixation. We suggest that resection must include the whole mucosa with intestinal metaplasia, in order to avoid leaving a synchronous tumor in the gastric stump.