Rol actual del antígeno carcinoembrionario (CEA) en el manejo del cáncer de colon

El antígeno carcinoembrionario (CEA) es un marcador tumoral ampliamente empleado en el manejo del cáncer colorrectal, especialmente en el seguimiento de los pacientes resecados con intención curativa. El objetivo de esta revisión es actualizar el rol del CEA en el manejo de los pacientes intervenidos por un cáncer de colon estadios I-III considerando la mejor evidencia disponible. Dada la sensibilidad modesta en el tumor primario (40%), la cual sube al 60-80% en los casos de recidiva, se propone la medición precoz del marcador (alrededor del mes) de las resecciones R0, toda vez que el valor debiera estar normalizado, especialmente si estaba elevado en el preoperatorio. Una elevación sostenida o un alza > de 10 ng/ml en el control precoz es indicativo de enfermedad residual y/o a distancia, lo que implica un rastreo clínico intensivo. Aunque el CEA preoperatorio tiene un valor pronóstico categórico, el CEA postoperatorio precoz elevado parece tener un valor pronóstico de recidiva superior. Un seguimiento intensivo parece razonable en los pacientes con factores de riesgo de recidiva, lo que incluye la medición del CEA en forma seriada. El umbral óptimo del CEA es motivo de controversia, con una tendencia a bajar el nivel de corte considerado normal (< 5 ng/ml) en los últimos años), lo que podría mejorar el balance entre sensibilidad y especificidad del test. Nuevas técnicas como el ADN circulante en combinación con el CEA se han propuesto para mejorar la oportunidad del diagnóstico de una recidiva, actualmente en evaluación.

Carcinoembryonic antigen (CEA) is a tumor marker widely used in the management of colorectal cancer, especially in the follow-up of patients resected with curative intent. The objective of this review is to update the role of CEA in the management of patients operated on for stage I-III colon cancer considering the best available evidence. Given the modest sensitivity in the primary tumor (40%), which rises to 60-80% in cases of recurrence, early measurement of the marker (around a month) of R0 resections is proposed, since the value should be normalized, especially if it was elevated preoperatively. A sustained elevation or a rise > 10 ng/mL at early check-up is indicative of residual and/or distant disease, which implies intensive clinical follow-up. Although preoperative CEA has a strong prognostic value, elevated early postoperative CEA seems to have a higher prognostic value for recurrence. Intensive follow-up seems reasonable in patients with risk factors for recurrence, which includes serial CEA measurement. The optimal CEA threshold is controversial, with a tendency to lower the cut-off level considered normal (< 5 ng/ml) in recent years), which could improve the balance between test sensitivity and specificity. New techniques such as circulating DNA in combination with CEA have been proposed to improve the chance of diagnosing a recurrence, currently under evaluation.

Pancreatic cystic lesions. Differential diagnosis and treatment strategy.

The differential diagnosis of pancreatic cystic lesions (PCLs) includes non-neoplastic lesions and neoplastic epithelial lesions. Given that management is determined by the risk for malignant progression, associated symptoms, and other characteristics, an accurate diagnosis is imperative. The present review attempts to provide a critical path that facilitates the characterization and management of PCLs.

The correlation between tumor markers and Ga-68 DOTA-TATE PET/CT findings in patients with advanced medullary thyroid cancer. / La correlación entre los marcadores tumorales y los hallazgos de Ga-68DOTA-TATE PET/TC en pacientes con cáncer medular de tiroides avanzado.

BACKGROUND: Medullary thyroid cancer is a rare type of neuroendocrine tumor. Calcitonin (Ctn) and carcinoembryonic antigen (CEA) are used as markers for medullary thyroid cancer. The aim of the study was to evaluate the importance of serum Ctn and CEA levels in predicting total tumor volume. MATERIAL AND METHODS: Ga-68 DOTA-TATE PET/CT findings such as whole-body somatostatin receptor-expressing metabolic tumor volume (SSR-E MTV) and total lesion volume (SSR-E TLV) were calculated and correlation analysis was done for tumor markers and whole-body SSR-E MTV and TLV. RESULTS: A total of 28 patients with advanced medullary thyroid cancer were included in this retrospective study. In the correlation analysis, there was a statistically significant positive correlation between Ctn and whole-body SSR-E MTV (rho=0.503 and P=.008). Similarly, significant positive correlation was observed between Ctn and whole-body SSR-E TLV (rho=0.436 and P=.023). There was a significant positive correlation between CEA and whole-body SSR-E MTV (rho=0.584 and P=.007). Also, a positive correlation was observed between CEA and whole-body SSR-E TLV (rho=0.436 and P=.023). These correlations were most marked in patients with Ctn≥152pg/mL and/or both nodal and bone involvement. CONCLUSION: These results could stimulate clinicians to perform Ga-68 PET for treatment decisions, especially in patients with high CEA and Ctn levels at the time of diagnosis.

Rendimiento del antígeno carcinoembrionario como prueba diagnóstica del cancer colorrectal / Effectiveness of carcinoembryonic antigen to diagnose colorectal cancer / Desempenho do antígeno carcinogênico embrionário como teste diagnóstico do câncer colorretal

Resumen: Introducción: el antígeno carcinoembrionario (CEA) es un marcador tumoral de seguimiento y no una prueba de tamizaje y diagnóstico en cáncer colorrectal (CCR). Sin embargo, en la práctica clínica habitual se continúa solicitando con fines de diagnóstico inicial. Objetivo: evaluar el rendimiento del CEA para el diagnóstico de CCR en el Hospital Maciel y en la Cooperativa Médica de Florida, en el período 2000-2019. Material y método: se trata de un estudio prospectivo de evaluación del CEA como prueba diagnóstica del CCR. Los criterios de inclusión fueron: 1) videocolonoscopía total en los usuarios sin CCR y videocolonoscopía total o parcial para aquellos con CCR y la confirmación histológica de adenocarcinoma; 2) contar con determinación de CEA dentro de los 30 días previos o posteriores a la videocolonoscopía, y 3) para la estadificación, el informe anatomopatológico de la pieza quirúrgica y la confirmación histológica de metástasis a distancia. El número de casos incluidos se determinó por un mínimo de diez casos en cada celda de la tabla de contingencia. Resultados: se analizaron 211 casos. El análisis general determinó una sensibilidad de 33,6%, especificidad 70,4%, valor predictivo positivo (VPP) 69,1%, valor predictivo negativo (VPN) 35%, exactitud 45,9%. Para el estadio II, sensibilidad 18,8%, especificidad 70,4%, VPP 30%, VPN 56,2%, exactitud 49,5%. Estadio III: sensibilidad 31,6%, especificidad 70,4%, VPP 36,4%, VPN 65,8%, exactitud 56,8%. Estadio IV: sensibilidad 65%, especificidad 70,4%, VPP 55,3%, VPN 78,1%, exactitud 68,4%. Conclusiones: el CEA como prueba de confirmación diagnóstica del CCR muestra un bajo rendimiento, siendo aun menor en estadios precoces de la enfermedad.

Summary: Introduction: carcinoembryonic antigen (CEA) is a tumor marker used for follow up rather than a screening and diagnostic test for colorectal cancer (CCR). However, it continues to be requested in the regular clinical practice for initial diagnosis. Objective: to evaluate the effectiveness of CEA to diagnose colorectal cancer at Maciel Hospital and Cooperativa Medica de Florida Hospital from 2000 to 2019. Method: prospective study to evaluate CEA as a diagnostic test for colorectal cancer. The following inclusion criteria were used: 1) total videocolonoscopy in all users without CLC and total or partial videocolonoscopy for those with CRC and histologic confirmation of adenocarcinoma; 2) CEA determination within 30 days before or after videocolonoscopy and 3) for the purpose of staging, pathology report of the surgical piece and histological confirmation of distant metastases. The number of cases included was defined by a 10-case minimum in each cell of the contingency table. Results: 211 cases were analysed. The general analysis revealed 33.6% sensitivity, 70.4% specificity, VPP 69.1%, VPN 35%, accuracy 45.9%. In the case of staging II, sensitivity was 18.8%, specificity 70.4%, VPP 30%, VPN 56.2%, accuracy 49.5%. In the case of staging III, sensitivity 31.6%, specificity 70.4%, VPP 36.4%, VPN 65.8%, accuracy 56.8%. In the case of staging IV, sensitivity 65%, specificity 70.4%, VPP 55.3%, VPN 78.1%, accuracy 68.4%. Conclusions: CEA evidences low effectiveness to diagnose colorectal cancer, and it is still less effective in early stages of the disease.

Resumo: Introdução: o antígeno carcinogênico embrionário (CEA) é um marcador tumoral de acompanhamento e não um teste de rastreamento e diagnóstico em câncer colorretal (CRC). No entanto, na prática clínica de rotina, continua a ser solicitado nos diagnósticos iniciais. Objetivo: avaliar o desempenho do CEA no diagnóstico de câncer colorretal nos Hospitais Maciel de Montevidéu e da Cooperativa Médica de Florida, no período 2000-2019. Material e método: este é um estudo prospectivo avaliando o CEA como teste diagnóstico para câncer colorretal. Os critérios de inclusão foram: 1) videocolonoscopia total em usuários sem CCR e videocolonoscopia total ou parcial naqueles com CCR e confirmação histológica de adenocarcinoma; 2) determinação do CEA 30 dias antes ou após a videocolonoscopia e 3) estadiamento, laudo anatomopatológico da peça cirúrgica e confirmação histológica de metástases à distância. O número de casos incluídos foi determinado por um mínimo de 10 casos em cada célula da tabela de contingência. Resultados: foram analisados 211 casos. A análise geral determinou uma sensibilidade de 33,6%, especificidade 70,4%, VPP 69,1%, VPN 35%, precisão 45,9%. Para o estágio II, sensibilidade 18,8%, especificidade 70,4%, PPV 30%, NPV 56,2%, precisão 49,5%. Estágio III, sensibilidade 31,6%, especificidade 70,4%, PPV 36,4%, NPV 65,8%, precisão 56,8%. Estágio IV, sensibilidade 65%, especificidade 70,4%, PPV 55,3%, NPV 78,1%, precisão 68,4%. Conclusões: o CEA como teste de confirmação diagnóstica do câncer colorretal apresenta baixo desempenho, sendo ainda menor nos estágios iniciais da doença.

Diagnostic yield of endoscopic ultrasound with fine-needle aspiration in pancreatic cystic lesions. / Rendimiento diagnóstico de la punción mediante ultrasonografía endoscópica de las lesiones quísticas del páncreas.

INTRODUCTION: Despite advances in imaging techniques, in many cases they are insufficient to establish the diagnosis of pancreatic cystic lesions (PCL). There are few publications in our setting that evaluate the combination of several methods obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). The aim of the study was to evaluate the overall utility of EUS-FNA in the diagnosis of PCL. MATERIAL AND METHODS: Retrospective study based on a database updated prospectively of a cohort of patients referred for EUS-FNA due to PCL detected in an imaging test. The sensitivity, specificity and diagnostic yield of carcinoembryonic antigen (CEA), cytology and viscosity were studied to detect mucinous lesions. RESULTS: From November 2013 to April 2018, 122 EUS were performed for PCL. EUS-FNA was performed in 94/122 (77%) and 21/122 (17.2%) patients were operated on. We included 33/122 patients who had diagnostic confirmation by histology, imaging (serous cyst with typical pattern) or clinical evolution. The study of the ROC curve determined the cutoff point ≥419 ng/ml to differentiate mucinous/non-mucinous cystic lesions. The diagnostic yield of CEA was 87.5% (21/24), cytology 81.8% (27/33) and viscosity 84.4% (27/32). The three parameters in combination obtained the best result (30/33, 90.9%). CONCLUSION: The combination of CEA analysis, cytology and viscosity of pancreatic fluid obtained by EUS-FNA increases the performance in the diagnosis of mucinous pancreatic cystic lesions, with it being greater than 90%.

Comparison of serum NEDD-9, CA 15-3, and CEA levels and PET metabolic parameters in breast cancer patients with 18 F-FDG PET / CT

SUMMARY OBJECTIVE Analyze the over expression of neural precursor cell expressed developmentally down-regulated protein 9 (NEDD-9) deregulated associated with a poor prognosis in various carcinomas. Our objective was to investigate the relationship between the levels of NEDD-9, CA 15-3, and CEA and PET (SUVmax, MTV40, TLG40) with the clinical parameters of patients with breast cancer (BC). METHODS One hundred and eleven patients (82 BC patients who underwent 18F-FDG PET/CT and 29 healthy controls) were evaluated. SUVmax, MTV, and TLG of the primary tumor were compared with the molecular and histopathological subtypes. 18F-FDG, MTV, and TLG were evaluated based on the clinical data, i.e., nodal involvement, distant metastasis, ER and PR status, Ki-67, serum levels of NEDD-9, CA15-3, and CEA. We compared the NEDD-9 in the BC and healthy control groups. RESULTS The mean ± SD of SUVmax in the 82 patients was 13.0 ± 8.6. A statistically significant relationship (p = 0.022) was found between the molecular subtypes and 18F-FDG uptake. The relationship between 18F-FDG uptake and TLG measured in patients <50 years, ER-PR negativity, and HER2 positivity were statistically significant (p=0.015, 0.007, 0.046, and 0.001, respectively). MTV40, TLG40, and CA 15-3 in metastatic patients were statistically significant (p=0.004, 0.005, and 0.003, respectively). NEDD-9 in the BC group was significantly higher than in the healthy group (p=0.017). There was a positive correlation between SUVmax and Ki67 and CA 15-3; MTV40 and CEA; CA 15-3, CEA, SUVmax, and MTV40; a negative correlation was found between CEA, TLG40, and age. CONCLUSION The use of SUVmax, MTV40, and TLG40 parameters with NEDD-9 and tumor markers has been shown to provide a high diagnostic, predictive, and prognostic value for the management of BC. This is considered to be the basis of interventions focused on the treatment objectives related to NEDD-9.

RESUMO OBJETIVO Analisar a associação da superrexpressão das células NEDD-9 ao prognóstico negativo em vários tipos de carcinoma. Nosso objetivo foi investigar a relação entre os níveis de NEDD-9, CA 15-3 e CEA e PET (SUVmax, MTV40, TLG) e os parâmetros clínicos em pacientes com câncer de mama (CM). MÉTODOS Cento e onze pacientes (82 pacientes de CM submetidos a 18F-FDG PET/TC e 29 controles saudáveis) foram avaliados. SUVmax, MTV, e TLG do tumor primário foram comparados nos subtipos molecular e histopatológico. A captação de 18F-FDG, MTV, e TLG foi avaliada com base em dados clínicos (envolvimento nodal, metástase distante, status de ER e PR, Ki-67, níveis séricos de NEDD-9, CA15-3 e CEA). Foi comparada a NEDD-9 do grupo de CM e o controle saudável. RESULTADOS A média ± DP de SUVmax de 82 pacientes foi de 13,0 ± 8,6. Uma relação estatisticamente significativa (p=0,022) foi encontrada entre subtipos moleculares e captação de 18F-FDG. A relação entre captação de 18F-FDG e TLG medida em pacientes com idade <50 anos, ER-PR negativo e HER2 positivo foi estatisticamente significativa (p=0,015; 0,007; 0,046; e 0,001, respectivamente). MTV40, TLG40 e CA 15-3 em pacientes metastáticos foram estatisticamente significantes (p=0,004, 0,005 e 0,003, respectivamente). NEDD-9 no grupo BC foi significativamente maior do que no grupo saudável (p=0,017). Uma correlação positiva foi encontrada entre SUVmax e Ki67 e CA 15-3; MTV40 e CEA; CA 15-3, CEA, SUVmax e MTV40; uma correlação negativa foi encontrada entre CEA, TLG40 e idade. CONCLUSÃO O uso dos parâmetros SUVmax, MTV40 e TLG40 com NEDD-9 e marcadores tumorais demonstrou um alto valor diagnóstico, preditivo e prognóstico para o manejo do CM. Isso é considerado a base para intervenções focadas nos objetivos de tratamento relacionados às NEDD9.

Biomarcadores mamarios en procesos metastásicos en mujeres ecuatorianas / Breast biomarkers in metastatic processes in Ecuadorian women

Resumen Introducción: Los biomarcadores tumorales CA 15-3 y CEA son predictores de metástasis en el cáncer de mama; no obstante, existe división de criterios de las ventajas de determinarlos de forma individual o conjunta. Objetivo: Evaluar la asociación de los biomarcadores tumorales CA 15-3 y CEA, por separado y en conjunto, en relación a la enfermedad metastásica en mujeres ecuatorianas con cáncer de mama. Métodos: Se realizó un estudio de prevalencia, en base a la información obtenida de las historias clínicas de 90 mujeres con cáncer de mama. Se identificaron los marcadores (CA 15-3, CEA y el conjunto de los dos (CA 15-3 ­ CEA) y se buscó la asociación con presencia o no de metástasis mediante prueba exacta de Fisher e índice Kappa de Cohen. Además, se determinó la sensibilidad, especificidad y valores predictivos positivos y negativos de cada marcador tumoral y en conjunto. Resultados: La prevalencia de carcinoma ductal invasivo en etapas localmente avanzadas de IIB a IIIC fue 77.8%. El sistema óseo y pulmonar fueron lugares frecuentes de invasión. De manera individual y conjunta existe una relación estadísticamente significativa (P <0.05) entre el valor de los biomarcadores y la presencia de procesos metastásicos, siendo CA15-3 y CA15-3-CEA los de mayor concordancia. CA15-3 presentó sensibilidad (S) 55% y especificidad (E) 91%. CEA tuvo (S) 30%; (E) 96%. En conjunto presentaron (S) 40%; (E) 100%. Conclusiones: La presencia de metástasis y mayor carga tumoral se correlacionan con la positividad de los biomarcadores tumorales CA 15-3-CEA, lo cual refuerza la utilidad clínica de evaluar los dos biomarcadores en conjunto.

Background: CA 15-3 and CEA tumor markers are metastasis predictors in breast cancer; however, criteria of the advantages in determining them in an individual or joint way are still not consensual. Objective: To evaluate the association of CA 15-3 and CEA tumor markers, in individual or joint way, in Ecuadorian patients diagnosed with metastatic breast cancer. Methods: A prevalence study was carried out, based on the information obtained from the medical records of 90 women with breast cancer. The markers CA 15-3, CEA were identified individually and together (CA 15-3 - CEA) and the association between the presence or absence of metastasis was established by using Fisher's exact test and Cohen's Kappa index. In addition, the sensitivity, specificity, positive and negative predictive values of each tumor marker as individual element and as a whole were determined Results: The prevalence of invasive ductal carcinoma in locally advanced stages from IIB to IIIC was 77.8%. The bone and lung system were frequent sites of cancer spread. There was a statistically significant relation (p<0.05) between the individual or whole biomarkers values and the presence of metastatic processes, being CA 15-3 and CA 15-3-CEA the ones with the highest concordance. CA 15-3 presented 55% sensitivity and 91% specificity. CEA presented 30% sensitivity and 96% specificity. As a whole, those have 40% sensitivity and 100% specificity. Conclusions: A higher tumor burden and metastatic development correlate with CA15-3-CEA biomarker positivity as a set, reinforcing the clinical benefit of evaluating both biomarkers simultaneously

Variações dos valores séricos do CEA, bilirrubinas e aminotransferases em indivíduos oncológicos / Variations of serum values of CEA, bilirubins and aminotransferases in oncologic individuals

Objetivo: esta pesquisa baseou-se na determinação sérica de marcadores biológicos importantes, em indivíduos oncológicos, para uma possível detecção prognóstica de cân- cer colorretal, tais como o CEA (antígeno carcinoembrionário), as aminotransferases (ALT e AST) e a bilirrubina total (BT) e suas frações direta (BD) e indireta (BI). Métodos: prontuários arquivados de indivíduos (n=80), atendidos no ambulatório e sob internação do setor de oncologia do Hospital Barão de Lucena, localizado em Recife, Pernambuco, Brasil, foram catalogados para análise. O estudo de coorte transversal foi adotado para se avaliar a prevalência de positividade do CEA, correlacionada com os índices séricos eleva- dos das bilirrubinas e aminotransferases. Resultados: o percentual mais elevado de indivíduos com valores alterados, em cada marcador biológico analisado, correspondeu ao sexo masculino, com a maior diferença observada para BI (44,0% vs. 18,2%). O percentual de resultados com alteração para AST, BT, BD e BI foi correspondentemente maior entre os indivíduos que expressaram valores de CEA alterados, com as duas maiores diferenças constatadas para BT (20,6% vs.8,7%) e BI (35,3% vs.19,6%). Conclusão: a associação dos biomarcardores séricos (CEA, bilirrubinas e aminotransferases) não demonstrou resultados significativos. Entretanto, valores do CEA alterados não podem ser desconsiderados, pois, quando averiguados isoladamente, inferem um possível risco de desenvolvimento de neoplasias do sistema digestório, principalmente na região colorretal, assim como da mama, do pulmão e do ovário.

Utilidad de la Proteína Epididimal Humana 4 (HE4) en la detección de Cáncer de ovario / Usefulness of the Human Epididymis protein 4 (HE4) in the detection of ovarian cancer

Introducción: El cáncer de ovario epitelial aunque tiene baja prevalencia está considerado entre las malignidades ginecológicas más letales por su alta mortalidad. El interés en la detección temprana del cáncer de ovario como mecanismo para lograr la reducción de la mortalidad ha crecido con el descubrimiento de biomarcadores tumorales séricos asociados a tumores malignos. El presente estudio plantea determinar la eficacia del uso del biomarcador HE4 para la detección precoz de cáncer epitelial de ovario en estadios tempranos. Métodos: Se evaluaron pacientes con masas pélvicas entre abril de 2015 y marzo de 2016. Valores de sensibilidad, especificidad, predictivo positivo y negativo, razón de probabilidad positiva y negativa, y pruebas estadísticas fueron calculados para determinar la relación entre los estados menopáusicos, y los grupos de acuerdo con el resultado histológico (benigno, maligno y control) de HE4, CA125 y ROMA. Resultados: Ingresaron al estudio 53 pacientes. La proteína epididimal humana 4 - HE4 presentó un valor medio diferenciable que permite distinguir masas pélvicas malignas (HE4:7,19 (maligno) vs. 5,71 (benigno)), igualmente la combinación HE4 + ROMA presentan mayor sensibilidad y especificidad (S: 100 %; E: 94.29 %) que las combinaciones CA125 + HE4 y CA125 + ROMA (S: 80 % y 88.89 %; E: 75.76 % y 77.14 %). Conclusión: Los resultados sugieren que HE4 serviría como un biomarcador eficiente para la diferenciación de masas pélvicas en estadios tempranos y si se adiciona el estatus menopaúsico, e índice ROMA afianzaría los resultados, permitiendo la diferenciación del cáncer de ovario epitelial en estadios tempranos en el país.

Introduction: Although epithelial ovarian cancer (EOC) has a low prevalence, it is considered among the most lethal gynecological malignancies due to its high mortality. The interest in the early detection of ovarian cancer as a mechanism to achieve the reduction of mortality has grown with the discovery of serum tumor biomarkers associated with malignant tumors. The present study proposes to determine the efficacy of the use of the HE4 biomarker for the early detection of ovarian epithelial cancer in early stages. Methods: We evaluated 53 patients with pelvic masses between April 2015 and March 2016. Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratio, and statistical tests were calculated to determine the relationship between menopausal states, and groups according to the histological result (benign, malignant and control) of HE4, CA125 and ROMA. Results: The human epididymal protein 4 - HE4 presented a differentiable mean value that allows to distinguish malignant pelvic masses (HE4: 7.19 (malignant) vs. 5.71 (benign)), likewise the combination HE4 + ROMA present greater sensitivity and specificity (S: 100%; E: 94.29 %) than combinations CA125 + HE4 and CA125 + ROMA (S: 80% and 88.89 %; E: 75.76 % and 77.14 %). Conclusion: The results suggest that HE4 would serve as an efficient biomarker for the differentiation of pelvic masses in early stages and if menopausal status is added, and ROMA index would strengthen the results, allowing the differentiation of epithelial ovarian cancer in early stages in the country.

Tumor ovárico benigno proliferante mucinoso de tipo endocervical con hiperplasia microglandular / Benign mucinous endocervical type ovarian tumor with microglandular hyperplasia

Resumen Antecedentes La aparición más común de la hiperplasia micro-glandular es en el endocérvix, luego en sitios con epitelio glandular mucinoso; en el ovario es excepcional. Se ha descrito posterior a la exposición a la progesterona como anticonceptivo, sin antecedente de exposición hormonal y en mujeres posmenopáusicas. En 2014 la OMS clasificó los tumores mucinosos de ovario como: mucinosos fronterizos (borderline), seromucinosos fronterizos (tumores mucinosos de tipo endocervical-mülleriano) y carcinoma mucinoso. Objetivo Exponer el diagnóstico de una tumoración ovárica benigna infrecuente, en una paciente que recibió estimulación hormonal con fines reproductivos. Caso clínico Paciente de 38 años, con hallazgo ecográfico de formación quística de 25 x 33 mm de pared gruesa e irregular, con papila de 6 mm vascularizada y el resto de contenido quístico heterogéneo. La paciente había recibido hiperestimulación ovárica controlada en cuatro ocasiones, la última seis meses previos al hallazgo, momento en que recibía anticoncepción combinada, previa a un nuevo ciclo. Se le practicó anexectomía derecha y lavado peritoneal. El diagnóstico anatomopatológico fue de tumor mucinoso proliferante, de tipo endocervical, con hiperplasia microglandular y citología del líquido aspirado, inflamatoria. El perfil inmunohistoquímico fue: citoqueratina7 positiva y citoqueratina 20, CDX2 (proteína homeobox) y antígeno carcinoembrionario negativos. El anticuerpo monoclonal Ki-67 fue menor de 10%. Los receptores de estrógenos fueron focalmente positivos y los de progesterona positivos de forma difusa e intensa. La paciente evolucionó favorablemente después del tratamiento. Conclusiones La hiperplasia microglandular puede aparecer en tumores mucinosos benignos de ovario y hay que considerar su posible implicación hormonal.

Abstract Background Microglandular hyperplasia is most commonly located in the endocervix, but may appear in any location with mucinous glandular epithelium. Ovarian presentation is exceptional. It has been described in women after exposure to progesterone as contraceptive, without history of hormonal exposure and in postmenopausal. In 2014, WHO classified mucinous ovarian tumors as borderline mucinous, borderline seromucinous (mucinous tumors of the endocervical/mül-lerian type) and mucinous carcinoma. Objective To describe the diagnosis of an uncommon benign ovarian tumor in a patient who underwent hormonal stimulation for reproductive purposes. Clinical case 38-year-old patient with an ultrasound finding of a 25 x 33mm cystic formation with a thick and irregular wall, a 6mm vascularized papilla and a heterogeneous cystic content. The patient had undergone controlled ovarian hyperstimulation on four occasions, the last one 6 months prior to the finding, when she was on combined contraception prior to a new cycle. Right adnexectomy and peritoneal lavage were performed. The anatomopathological diagnosis was an endocervical mucinous proliferative tumor with microglan-dular hyperplasia and inflammatory cytology of the aspirated fluid. The immunohistochemical profile was: cytokeratin 7 positive and cytokeratin 20, CDX2 (homeobox protein) and CEA (carcinoembry-onic antigen) negative. The monoclonal antibody Ki-67 was < 10%. Estrogen receptors were focally positive and progesterone receptors positive in a diffuse and intense form. After treatment, the patient had a favorable evolution. Conclusions Microglandular hyperplasia may be present in ovarian mucinous benign tumors. A hormonal involvement should be considered.

Porocarcinoma Ecrino / Ecrine Porocarcinoma

Resumen:El porocarcinoma ecrino es un tipo muy poco frecuente de cáncer de piel, originado en la porción epidérmica de las glándulas sudoríparas ecrinas. Representa no más del 0.01% de los tumores cutáneos. El 20% de los porocarcinomas ecrinos son recurrentes y el 20% producen metástasis a ganglios linfáticos. Se ha reportado escasos casos de metástasis a distancia. Tiene un índice de mortalidad del 67% de los pacientes con metástasis.El diagnóstico es basado en los hallazgos histopatológicos y los estudios complementarios de inmunohistoquímica, a veces necesarios para el diagnóstico diferencial con otros tipos más frecuentes de cáncer de piel.No existen pruebas de que este tipo de carcinoma responda a la quimioterapia ni la radioterapia. Se considera que el manejo principal debe ser la resección quirúrgica y la electroquimioterapia.

Abstract:Eccrine porocarcinoma is a rare type of skin cáncer arising from the intraepidermal portion of eccrine sweat glands, representing no more tan 0.01% of all cutaneous tumors. 20% of the Eccrine porocarcinoma will recur and 20% will metastasize to regional lymph nodes. Few cases of distant metastases has been reported . There is a mortality rate of 67% in patients with metastases. The diagnosis is primarily based on histopathologic findings and complementary immunohistochemistry for differential diagnosis mainly with more frequent skin cáncer.Neither chemotherapy nor radiation therapy has been proven to be of clinical benefit in treating this type of carcinoma. It is considered that the management should be based on surgical resection and electrochemotherapy.

Utilidad clínica del Antígeno Carcinoembrionario (ACE), Tomografía convencional (TC) y PET-CT en el diagnóstico de adenocarcinoma colorrectal recidivante / Clinical utility of Carcinoembryonic Antigen (ACE), conventional tomography (CT) and PET-CT in the diagnosis of recurrent colorectal adenocarcinoma

Introduction: Colorectal cancer is one of the most prevalent tumors in the world. In the surveillance setting of recurrent colorectal cancer, laboratory test like carncinoembryonic antigen (CEA) and imaging tests like computed tomography (CT) and positron emission tomography (PET/CT) are available. We performed this study to establish the predictive accuracy of these tests to an early identification of recurrent colorectal cáncer. Materials and Methods: Thirty six patients at stages I , III and IV, after single metastasis resection of colorectal cáncer were identified. We assessed the utility of CEA, CT and PET-CT in the follow-up of these patients to improve the diagnosis of recurrent disease. Results: Of 36 studied patients, 27 /75%) had recurrence; the median age was 61 year-old and the median lap-time 16 months. The PET PET/CT scan obtained the following results: sensitivity 96.7%, specificity 88.9%, positive predictive value 96.3%, negative predictive value 88.9%, positive likekihood ratio 8.7 and negative likelihood ratio 0.04. Discusion: The best tool to make diagnosis of colorectal cancer and its recurrence is PET­CT, however, none of these tests could make the diagnosis by themselves. It has to be confirmed by histopathologic studies plus other exams.

[Prognostic value of preoperative carcinoembryogenic antigen: Is it useful in all stages of colorectal cancer?]. / Valor pronóstico pretratamiento del antígeno carcinoembrionario en el cáncer colorrectal operado. ¿Es útil en todos los estadios del tumor?

INTRODUCTION: Recent reports have reopened discussion of the prognostic value of elevated pre-treatment carcinoembryonic antigen (CEA) levels in colorectal cancer. Due to the discrepancies in the published results, we aimed to analyze the possible predictive value of CEA, both overall and in different tumoral stages in our environment. PATIENTS AND METHODS: We retrospectively studied 303 consecutive patients with colorectal cancer resected with curative intent by analysing tumor-related mortality. The frequency of patients with increased CEA levels (> 5mg/l) was registered. Univariate and multivariate analyses of survival curves were performed, comparing patients with increased CEA levels and those with CEA levels within normal limits, both in the overall series and in the different pTNM tumoral stages. RESULTS: Frequency of patients with CEA>5mg/l was 31%. The median clinical follow-up was 83 months. A poor survival rate was registered in the multivariate analysis of the whole series in patients with high CEA levels: hazard ratio (HR)=1.81; 95% confidence interval (95% CI)=(1.15-3.10); P=.012. This predictive value was only maintained in stage II in the survival analysis of the distinct tumoral stages (n=104): HR=3.02; 95% CI=(1.22-7.45); P=.017. CONCLUSIONS: Before treatment, 31% of our patients with colorectal cancer resected with curative intent had pathological CEA values. In the overall series, a high pretreatment CEA level showed an independent prognostic value for poor survival. When pTNM tumoral stages were analyzed separately, CEA level had predictive value only in pTNM II tumors.

Consensus on the management of advanced medullary thyroid carcinoma on behalf of the Working Group of Thyroid Cancer of the Spanish Society of Endocrinology (SEEN) and the Spanish Task Force Group for Orphan and Infrequent Tumors (GETHI).

BACKGROUND: In Spain medullary thyroid carcinoma (MTC) would not exceed 80 new cases per year and less than half of them would be good candidates for systemic treatment with novel agents. METHODS: Relevant literature was reviewed, including PubMed searches supplemented with additional articles. RESULTS: The consensus summarizes the clinical outcomes in terms of activity and toxicity of each of the available drugs. A brief summary of the minimum requirements in terms of follow up and genetic counseling around MTC is also included. CONCLUSIONS: Only those patients with objective imaging progression in the last 12-14 months with large volume of disease are clear candidates to start systemic treatment. However, those patients with low disease volume should be considered for 'wait and see' strategy until symptoms of the disease appear. Multidisciplinary approach for the management of MTC patient is mandatory nowadays.

[Diagnostic capability of carcinoembryonic antigen elevation]. / Capacidad diagnóstica del antígeno carcinoembrionario.

INTRODUCTION: There is little information on the oncologic diagnostic accuracy of carcinoembryonic antigen (CEA) levels more than 3-fold above normal. OBJETIVES: To determine the prevalence of underlying cancer in patients with mild CEA elevation and the mean cost per patient of CEA determination. METHODS: A retrospective study was carried out in all patients with CEA elevation (3-10 ng/ml) and suspicion of cancer referred to the gastroenterology or internal medicine outpatient units from 2001 to 2007. RESULTS: We studied 100 patients (60 men and 40 women), with a mean age of 67.4 ± 14.2 years and baseline CEA of 5.8 ± 1.7 ng/ml. The most important symptoms and signs were laboratory abnormalities (19 patients [19%]). Cancer was diagnosed in 4 patients (one gastric, 2 lung and one colon). Among patients without malignancies, 49 patients (49%) had no related processes, and 47 (47%) had benign diseases. During follow-up, one laryngeal cancer, one acute myeloid leukemia, and one colon cancer were detected (54.3 ± 24.6 months). We found no differences between baseline CEA levels in patients with and without cancer (6.6 ± 2.4 vs. 5.8 ± 1.7 ng/ml, p = 0.2). The mean cost per patient was 503.6 ± 257.6 €. CONCLUSIONS: Cancer was detected in a small proportion (7%) of patients with mild CEA elevation. The study of these patients is directly and indirectly associated with a not inconsiderable cost.

Antígeno carcinoembrionario en la recurrencia y sobrevida de pacientes con resección curativa de cáncer colorrectal / Carcinoembryonic antigen in recurrence and survival of patients with resection of colorectal cancer

Introducción: El antígeno carcinoembrionario (CEA) ha sido asociado con estadios avanzados, pobre sobrevida y detección temprana de recurrencia de cáncer colorrectal (CCR). Objetivos: Establecer la relación entre la concentración sérica de CEA con la recurrencia y sobrevida de pacientes con resección curativa de cáncer colorrectal. Diseño: Estudio retrospectivo, correlacional y explicativo. Institución: Departamento de Cirugía General, Servicio de Colon y Recto, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú. Población: Pacientes con resección curativa de CCR. Métodos: Los pacientes con resección curativa de CCR en el hospital Rebagliati, durante los años 2000-2003, tuvieron seguimiento hasta el año 2010. Se usó la diferencia de medias a través de la prueba T, para la comparación de variables cuantitativas. Se recurrió a técnicas de análisis de sobrevida a través del método de Kaplan-Meier y la regresión de Cox. Principales medidas de resultados: Recurrencia y sobrevida de pacientes. Resultados: La concentración sérica elevada de antígeno carcinoembrionario en el pre y postoperatorio reveló una mayor recurrencia significativa de cáncer colorrectal (p<0,05). La sobrevida en los pacientes con CEA patológico fue significativamente menor que en los pacientes con CEA normal (p<0,05). Conclusiones: La concentración sérica elevada de CEA, demostró una mayor recurrencia del cáncer colorrectal. El valor sérico de CEA en el preoperatorio constituye un valor predictivo de sobrevida...

Introduction: Carcinoembryonic antigen (CEA) has been associated with advanced stage, poor survival and early detection of recurrent colorectal cancer (CRC). Objectives: To determine relation between serum CEA and recurrence and survival of patients with curative resection of colorectal cancer. Design: Retrospective, correlational and explanatory study. Setting: Department of General Surgery, Service of Colon and Rectum, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru. Participants: Patients with curative resection of CRC. Methods: Patients with curative resection of CRC at Rebagliati Hospital during years 2000-2003 were followed until 2010. T test mean differences was used for variables quantitative comparison, and Kaplan-Meier method and Cox regression survival analysis techniques were also used. Main outcome measures: Patients recurrence and survival. Results: Increased serum CEA in the pre and postoperative periods was related to significant increased recurrence of colorectal cancer (p<0.05). Survival in patients with pathological CEA was significantly lower than in patients with standard CEA (p<0.05). Conclusions: Elevated serum carcinoembryonic antigen was related to increased colorectal cancer recurrence. Serum CEA values in the preoperative period would predict survival...

Estudio comparativo de dos métodos para la cuantificación del antígeno carcinoembrionario / Comparative study of two methods for carcinoembryonic antigen quantification / Estudo comparativo de dois métodos para a quantificação do antígeno carcinoembrionário

El antígeno carcinoembrionario (CEA) es una glicoproteína ampliamente utilizada como complemento del diagnóstico, monitoreo de tratamiento y evolución del cáncer colorrectal. El objetivo del presente trabajo fue realizar un análisis comparativo entre dos métodos para la determinación de CEA: electroquimioluminiscencia y quimioluminiscencia, en muestras de suero de 57 pacientes con diagnóstico de cáncer, principalmente colorrectal. Cuando se analizaron los datos totales se obtuvo una elevada correlación (r=0,9135, p<0,00001). Al realizar un corte de los resultados tomando como límite el valor de 4 ng/mL se observó que las mayores discrepancias entre métodos estuvieron en los valores considerados dentro del rango normal (r=0,5716, p<0,0014, n=29). Por el contrario, en concentraciones mayores al límite de corte, la correlación fue elevada (r=0,9453, p<0,00001, n=28). Estos resultados sugieren que, a diferencia de lo descripto por los fabricantes, los valores de CEA obtenidos por ambos métodos son comparables. La menor correlación observada en concentraciones inferiores a 4 ng/mL no sería tan relevante debido a que estos niveles se consideran dentro del rango de normalidad y, por lo tanto, su importancia desde el punto de vista clínico es relativa. Sin embargo, debido a que pueden detectarse con baja frecuencia diferencias individuales (atribuidas probablemente a diferencias en los epitopes detectados por cada método), para los casos con fuerte presunción clínica y un valor de CEA incongruente, se sugiere repetir la determinación por medio de otra metodología.

The carcinoembryonic antigen (CEA) is a glycoprotein widely employed in colorectal cancer, mainly as evolutive marker and as measure of therapy's ef-ficacy. The goal of this work was to perform a comparative study between two analytical methods to measure serum CEA levels: electrochemiluminescence (ECL) and chemilumines-cence (CL) in serum samples of 57 patients with diagnosis of cancer, mainly colorectal. On the whole, an elevated correlation between ECL and CL (r=0.9135; p<0.00001) was obtained. When data was analyzed with a cut-off value of 4 ng/mL, the main discrepancy between methods occurred in the range of normal values (r=0.5716; p<0.0014; n=29). On the contrary, in concentrations higher than the cut-off, the cor-relation was very high (r=0.9453; p<0.00001; n=28). These results suggest that, in spite of the reports of manufacturers, the CEA values obtained by both methods are comparable. The lower correlation observed in values below 4 ng/mL would not be significant because those values are in the normal range and, for that reason, their clinical importance is minor. However, due to the individual differences that could be detected in some patients (probably resulting from the differences in epitopes detected by each method), in cases with strong clinical evidence without concordance with the CEA result, it could be necessary to repeat the determination using another methodology.

O antígeno carcinoembrionário (CEA) é uma glicoproteína amplamente usada como complemento do diagnóstico, monitoração de tratamento e evolução do câncer colorretal. O objetivo deste trabalho foi realizar uma análise comparativa entre dois métodos para a detecção do CEA: eletroquimioluminescência e quimio-luminescência em amostras de soro de 57 pacientes com diagnóstico de câncer, principalmente colorretal. Quando analisados os dados totais, houve uma correlação elevada (r=0,9135, p<0,00001). Quando realizado um corte dos resultados tomando como valor limite 4 ng/mL, observou-se que as maiores diferenças entre ambos os métodos estiveram nos valores considerados dentro da faixa dos valores normais (r=0,5716, p<0,0014, n=29). No entanto, nas concentrações superiores respeito do limite de corte, a correlação foi elevada (r=0,9453, p<0,00001, n=28). Estes resultados sugerem que, comparado com o descrito pelos fabricantes, os valores de CEA obtidos por ambos os métodos são comparáveis. A menor correlação observada nas concentrações inferiores a 4 ng/mL não seria tão relevante devido a que estes níveis consideram-se dentro da faixa de normalidade e, portanto, sua importância, do ponto de vista clínico, é relativa. Contudo, devido a que podem ser detectados com baixa frequência diferenças individuais (atribuídas provavelmente a diferenças nos epitopos detectados por cada método), para os casos com forte suspeita clínica e um valor de CEA incongruente, sugere-se repetir a determinação através de outra metodologia.

Estudio comparativo de dos métodos para la cuantificación del antígeno carcinoembrionario / Comparative study of two methods for carcinoembryonic antigen quantification / Estudo comparativo de dois métodos para a quantificaþÒo do antígeno carcinoembrionário

El antígeno carcinoembrionario (CEA) es una glicoproteína ampliamente utilizada como complemento del diagnóstico, monitoreo de tratamiento y evolución del cáncer colorrectal. El objetivo del presente trabajo fue realizar un análisis comparativo entre dos métodos para la determinación de CEA: electroquimioluminiscencia y quimioluminiscencia, en muestras de suero de 57 pacientes con diagnóstico de cáncer, principalmente colorrectal. Cuando se analizaron los datos totales se obtuvo una elevada correlación (r=0,9135, p<0,00001). Al realizar un corte de los resultados tomando como límite el valor de 4 ng/mL se observó que las mayores discrepancias entre métodos estuvieron en los valores considerados dentro del rango normal (r=0,5716, p<0,0014, n=29). Por el contrario, en concentraciones mayores al límite de corte, la correlación fue elevada (r=0,9453, p<0,00001, n=28). Estos resultados sugieren que, a diferencia de lo descripto por los fabricantes, los valores de CEA obtenidos por ambos métodos son comparables. La menor correlación observada en concentraciones inferiores a 4 ng/mL no sería tan relevante debido a que estos niveles se consideran dentro del rango de normalidad y, por lo tanto, su importancia desde el punto de vista clínico es relativa. Sin embargo, debido a que pueden detectarse con baja frecuencia diferencias individuales (atribuidas probablemente a diferencias en los epitopes detectados por cada método), para los casos con fuerte presunción clínica y un valor de CEA incongruente, se sugiere repetir la determinación por medio de otra metodología.(AU)

The carcinoembryonic antigen (CEA) is a glycoprotein widely employed in colorectal cancer, mainly as evolutive marker and as measure of therapys ef-ficacy. The goal of this work was to perform a comparative study between two analytical methods to measure serum CEA levels: electrochemiluminescence (ECL) and chemilumines-cence (CL) in serum samples of 57 patients with diagnosis of cancer, mainly colorectal. On the whole, an elevated correlation between ECL and CL (r=0.9135; p<0.00001) was obtained. When data was analyzed with a cut-off value of 4 ng/mL, the main discrepancy between methods occurred in the range of normal values (r=0.5716; p<0.0014; n=29). On the contrary, in concentrations higher than the cut-off, the cor-relation was very high (r=0.9453; p<0.00001; n=28). These results suggest that, in spite of the reports of manufacturers, the CEA values obtained by both methods are comparable. The lower correlation observed in values below 4 ng/mL would not be significant because those values are in the normal range and, for that reason, their clinical importance is minor. However, due to the individual differences that could be detected in some patients (probably resulting from the differences in epitopes detected by each method), in cases with strong clinical evidence without concordance with the CEA result, it could be necessary to repeat the determination using another methodology.(AU)

O antígeno carcinoembrionário (CEA) é uma glicoproteína amplamente usada como complemento do diagnóstico, monitoraþÒo de tratamento e evoluþÒo do cÔncer colorretal. O objetivo deste trabalho foi realizar uma análise comparativa entre dois métodos para a detecþÒo do CEA: eletroquimioluminescÛncia e quimio-luminescÛncia em amostras de soro de 57 pacientes com diagnóstico de cÔncer, principalmente colorretal. Quando analisados os dados totais, houve uma correlaþÒo elevada (r=0,9135, p<0,00001). Quando realizado um corte dos resultados tomando como valor limite 4 ng/mL, observou-se que as maiores diferenþas entre ambos os métodos estiveram nos valores considerados dentro da faixa dos valores normais (r=0,5716, p<0,0014, n=29). No entanto, nas concentraþ§es superiores respeito do limite de corte, a correlaþÒo foi elevada (r=0,9453, p<0,00001, n=28). Estes resultados sugerem que, comparado com o descrito pelos fabricantes, os valores de CEA obtidos por ambos os métodos sÒo comparáveis. A menor correlaþÒo observada nas concentraþ§es inferiores a 4 ng/mL nÒo seria tÒo relevante devido a que estes níveis consideram-se dentro da faixa de normalidade e, portanto, sua importÔncia, do ponto de vista clínico, é relativa. Contudo, devido a que podem ser detectados com baixa frequÛncia diferenþas individuais (atribuídas provavelmente a diferenþas nos epitopos detectados por cada método), para os casos com forte suspeita clínica e um valor de CEA incongruente, sugere-se repetir a determinaþÒo através de outra metodologia.(AU)

Carcinoembryoni antigen levels in the peripherl and mesenteric venous blood oof patients with rectal carcinoma / Niveis do antigeno carcinoembrionico no sangue venoso periferico e mesenterico em doentes com carcinoma retal

Context The serum carcinoembryonic antigen (CEA) is an important prognostic factor in colorectal cancer, however the rectum presents different routes of venous drainage, stating that the level of CEA in peripheral and mesenteric rectal tumors may be different, depending on the location of the tumor in the rectal segment. Objective The goal of this study was to evaluate the relationship between the peripheral and mesenteric venous levels of CEA and the association between these levels and the tumour location in the rectums of patients successfully operated on for rectal carcinoma. Methods Thirty-two patients who were surgically treated for rectal carcinoma were divided into patients with tumours located in the upper rectum (n = 11) or lower rectum (n = 21). The CEA values were assessed by electrochemiluminescence immunoassay. Serum and mesenteric CEA levels were associated with the tumour anatomopathological characteristics: location, histological type, cellular differentiation grade, depth of invasion into the rectal wall, angiolymphatic invasion, tumour, node, and metastasis staging; and the CEA index (≤1.0 or ≥1.0 ng /mL). Results Analysis of the serum CEA values using clinical and anatomopathological parameters revealed no significant association with tumour location, histological type, cellular differentiation grade, depth of invasion into the intestinal wall, and tumour, node, and metastasis staging. The mesenteric CEA levels were significantly associated with the tumour location (P = 0.01). The CEA values in the mesenteric venous blood and the presence of angiolymphatic invasion (P = 0.047) were significantly different. A significant relationship was found between the CEA index value and the rectal tumour location (P = 0.0001). Conclusions The CEA levels were higher in the mesenteric vein in tumours located in the upper rectum and in the presence of angiolymphatic invasion. CEA drainage from lower rectum adenocarcinomas ...

Contexto O antígeno carcinoembriônico (CEA) sérico é um importante fator de prognóstico do câncer coloretal, contudo o reto apresenta diferentes vias de drenagem venosa, indicando que o nível do CEA periférico e mesentérico nos tumores retais podem ser diferentes, na dependência da localização da neoplasia no segmento retal. Objetivo Avaliar em doentes operados curativamente de carcinoma do reto, a relação entre o nível venoso periférico e portal do CEA e a associação desses níveis com a localização da neoplasia no reto. Método Trinta e dois doentes operados por carcinoma retal foram divididos em pacientes com tumores situados no reto alto (n = 11) e no reto baixo (n = 21). A análise dos valores de CEA foi determinada por imunoensaio de eletroquimioluminescência. As dosagens do CEA sérico e mesentérico foram associadas aos aspectos anatomopatológicos da neoplasia (localização da neoplasia, tipo histológico, grau de diferenciação celular, profundidade de invasão na parede retal, invasão angiolinfática); estadiamento tumor, nódulo e metástase e; ao índice do CEA (≤1,0 ou ≥1,0 ng/mL). Resultados A análise dos valores de CEA sérico com os parâmetros clínicos e anatomopatológicos não revelou associação significante com a localização do tumor, tipo histológico, grau de diferenciação celular, nível de profundidade de invasão na parede intestinal e estadiamento tumor, nódulo e metástase. Os valores dos níveis mesentéricos do CEA apresentaram associação significante com a localização do tumor (P = 0,010). Observou-se diferença significante entre os valores do CEA no sangue venoso mesentérico e a presença de invasão ...