Caecum lipoma: a rare cause of lower gastrointestinal bleeding.

Gastrointestinal bleeding caused by benign tumours of the colon is rare. A 70-year-old woman with a significant medical history of diabetes, hypertension and ischaemic heart disease was presented in consultation with marked anaemia secondary to lower gastrointestinal bleeding with a right colonic tumour found by CT. The patient underwent a right colectomy without complications. Histopathological examination revealed a 4 cm transmural caecum lipoma with mucosal ulceration. The patient is asymptomatic without anaemia at 6 months follow-up.

[Advances in surgical endoscopy: initial experience in endoscopic colonic submucosal dissection (ESD) in Costa Rica]. / Avances en cirugía endoscópica: experiencia inicial de disección endoscópicade la submucosa (DES) de colon en Costa Rica.

OBJECTIVES: To report the first case in Costa Rica of a colon tumor removed by endoscopic submucosal dissection (ESD). PATIENT AND METHOD: We describe the case of a 70-year-old man with a multilobulated 25 millimeters tumor located in the cecum, near the ileocecal valve, detected during a routine colonoscopic check-up. The biopsy revealed a tubular adenoma with high grade dysplasia and the patient underwent an endoscopic submucosal en-bloc dissection of the lesion. RESULTS: The procedure was successfully performed without complications such as bleeding or perforation. The operative time was 117 minutes. The histopathological analysis of the en-bloc specimen confirmed the diagnosis of high grade dysplasia with negative vertical and horizontal margins. CONCLUSION: Colon ESD is an attractive and safe treatment option for the removal of premalignant lesions and some types of early colon cancer.

[Gastrointestinal Epstein Barr virus positive diffuse large B cell lymphoma in elderly: report of five cases and review of literature]. / Linfoma de celulas grandes B difuso gastrointestinal del anciano asociado al virus Epstein Barr: reporte de cinco casos y revision de la literatura.

EBV-positive diffuse large B-cell lymphoma (DLBCL) in elderly is a new entity included provisionally in the most recent WHO Classification of lymphoid neoplasms. It usually affects elderly patients and has a poor survival. The goal of this report was to evaluate clinical, endoscopic characteristics and survival of five patients with this entity and gastrointestinal afectation. From five cases, three cases had gastric infiltration, one ileon and one in cecum.

Linfoma de Celulas Grandes B Difuso Gastrointestinal del Anciano Asociado al Virus Epstein Barr: Reporte de Cinco Casos y Revision de la Literatura / Gastrointestinal Epstein Barr Virus positive diffuse large B cell lymphoma in elderly: report of five cases and review of literatura

El Linfoma de Células Grandes B difuso del anciano asociado al Epstein Barr es una nueva entidad incluida provisionalmente en la más reciente clasificación de neoplasias linfoides de la WHO. Usualmente afecta ancianos y tiene pobre sobrevida. El objetivo de este reporte fue evaluar las característica clínicas, endoscópicas y sobrevida de cinco pacientes portadores de esta entidad y compromiso gastrointestinal. Tres casos tuvieron infiltración gástrica y dos casos tuvieron compromiso del ileón y el ciego.

EBV-positive diffuse large B-cell lymphoma (DLBCL) in elderly is a new entity included provisionally in the most recent WHO Classification of lymphoid neoplasms. It usually affects elderly patients and has a poor survival. The goal of this report was to evaluate clinical, endoscopic characteristics and survival of five patients with this entity and gastrointestinal afectation. From five cases, three cases had gastric infiltration, one ileon and one in cecum.

Hernia de Spiegel vs. neoplasia de colon: a propósito de un caso / Spigelian hernia vs. colonic neoplasias: apropos of a case

Las hernias de Spiegel son una entidad rara y ocurren a través de defectos de la fascia homónima. El diagnóstico es difícil; puede ser auxiliado por tomografía axial computarizada y ultrasonido. Se reporta el caso de una paciente de 46 años de edad, referida al servicio de Imágenes del Hospital Universitario Clínico-Quirúrgico Comandante Faustino Pérez, de Matanzas, con historia de dolor abdominal inespecífico desde hace cuatro años; ahora con masa abdominal palpable en cuadrante inferior derecho e imagen sugestiva de neoplasia de ciego en examen de colon por enema realizado en el hospital de referencia. Su diagnóstico puede ser virtualmente imposible a menos que la entidad sea previamente considerada, ahí radica la importancia del reporte(AU)

Spigelian hernias are a rare entity and occur through defects in the homonym fascia. The diagnosis is difficult; it may be helped by on-line axial tomography and ultrasound. We report the case of a 46- years-old patient remitted to the Imaging Service of the Clinical-Surgical University Hospital Comandante Faustino Pérez, of Matanzas, with a history of unspecific abdominal pain for four years, now with a palpable abdominal mass in the right lower quadrant and image suggesting cecum neoplasias in colon examination by enema made in the before mentioned hospital; their diagnosis may be virtually impossible unless the entity is previously considered; that is where the importance of the report resides(AU)

Hernia de Spiegel vs. neoplasia de colon: a propósito de un caso / Spigelian hernia vs. colonic neoplasias: apropos of a case

Las hernias de Spiegel son una entidad rara y ocurren a través de defectos de la fascia homónima. El diagnóstico es difícil; puede ser auxiliado por tomografía axial computarizada y ultrasonido. Se reporta el caso de una paciente de 46 años de edad, referida al servicio de Imágenes del Hospital Universitario Clínico-Quirúrgico Comandante Faustino Pérez, de Matanzas, con historia de dolor abdominal inespecífico desde hace cuatro años; ahora con masa abdominal palpable en cuadrante inferior derecho e imagen sugestiva de neoplasia de ciego en examen de colon por enema realizado en el hospital de referencia. Su diagnóstico puede ser virtualmente imposible a menos que la entidad sea previamente considerada, ahí radica la importancia del reporte

Spigelian hernias are a rare entity and occur through defects in the homonym fascia. The diagnosis is difficult; it may be helped by on-line axial tomography and ultrasound. We report the case of a 46- years-old patient remitted to the Imaging Service of the Clinical-Surgical University Hospital Comandante Faustino Pérez, of Matanzas, with a history of unspecific abdominal pain for four years, now with a palpable abdominal mass in the right lower quadrant and image suggesting cecum neoplasias in colon examination by enema made in the before mentioned hospital; their diagnosis may be virtually impossible unless the entity is previously considered; that is where the importance of the report resides

Mucinous cystadenoma of the appendix. Case report.

BACKGROUND: Pathology of the appendix represents >50% of surgical activity. It is necessary to consider rare pathologies such as mucoceles. These have a high frequency in females with a F/M ratio of 4:1, as well as in patients >50 years of age. The objective of this study is to report on a case of mucinous cystadenoma of the appendix. CLINICAL CASE: We present the case of a 34-year-old male with a history of juvenile rheumatoid arthritis diagnosed at 9 years of age. At 22 years of age, the patient underwent bilateral hip arthroplasty. Since 1998, the patient has presented with renal amyloidosis and has been under steroid treatment to date. The current problem evolved 1 year ago during control studies for his disease. Computed tomography (CT) of the abdomen was done, demonstrating a tumor in the right iliac fossa. Colonoscopy confirmed a tumor with smooth edges located in the cecum. Surgery was recommended with a diagnosis of lipoma of the cecum. During surgery, a large tumor was found, indicating a poor prognosis. Right hemicolectomy was done. Surgical specimen was sent to pathology with a report of mucinous cystadenoma. CONCLUSIONS: The group of symptoms of cystadenoma is nonspecific. Diagnostic methods include X-rays, ultrasound, CT and colonoscopy. Mucinous cystadenoma is the most common form of mucocele of the appendix. Diagnostic protocols are the same for benign appendix pathology. Treatment is surgical and type of surgery depends on the size of the mucocele. Mucoceles of the appendix are pathologies with a favorable prognosis when appropriate treatment is done.

Cistoadenoma mucinoso de apéndice: informe de un caso / Mucinous cystadenoma of the appendix: case report

Introducción: La patología apendicular representa más de 50% de la actividad quirúrgica general, y dentro de ésta hay que considerar las raras, entre las que se incluyen los mucoceles, cuya incidencia es mayor en mujeres (4/1) y en pacientes con edad superior a 50 años. El objetivo de este trabajo es informar un caso de cistoadenoma mucinoso de apéndice. Caso clínico: Hombre de 34 años de edad con diagnóstico a los nueve años de edad de artritis reumatoide juvenil; con prótesis bilateral de cadera a los 22 años. Presenta amiloidosis renal desde 1998 y se encuentra en tratamiento con esteroides hasta el momento de este informe. El cuadro clínico se inició un año atrás, cuando en una tomografía axial computarizada de abdomen de control se encontró tumoración en la fosa iliaca derecha, confirmada por colonoscopia en ciego. Por diagnóstico presuntivo de lipoma fue programado para cirugía; en el transoperatorio se encontró gran tumoración de pronóstico reservado, por lo que se decidió hemicolectomía derecha. El informe de patología de la pieza quirúrgica fue cistoadenoma mucinoso. Conclusiones: La sintomatología del cistoadenoma es inespecífica. Los métodos de diagnóstico incluyen rayos X, ultrasonido, tomografía axial computarizada y colonoscopia. El cistoadenoma es la forma más común de los mucoceles apendiculares y el protocolo de diagnóstico es igual que para patología de apéndice cecal. El tratamiento de elección es la cirugía y depende del tamaño del mucocele. El pronóstico es bueno con el tratamiento adecuado.

BACKGROUND: Pathology of the appendix represents >50% of surgical activity. It is necessary to consider rare pathologies such as mucoceles. These have a high frequency in females with a F/M ratio of 4:1, as well as in patients >50 years of age. The objective of this study is to report on a case of mucinous cystadenoma of the appendix. CLINICAL CASE: We present the case of a 34-year-old male with a history of juvenile rheumatoid arthritis diagnosed at 9 years of age. At 22 years of age, the patient underwent bilateral hip arthroplasty. Since 1998, the patient has presented with renal amyloidosis and has been under steroid treatment to date. The current problem evolved 1 year ago during control studies for his disease. Computed tomography (CT) of the abdomen was done, demonstrating a tumor in the right iliac fossa. Colonoscopy confirmed a tumor with smooth edges located in the cecum. Surgery was recommended with a diagnosis of lipoma of the cecum. During surgery, a large tumor was found, indicating a poor prognosis. Right hemicolectomy was done. Surgical specimen was sent to pathology with a report of mucinous cystadenoma. CONCLUSIONS: The group of symptoms of cystadenoma is nonspecific. Diagnostic methods include X-rays, ultrasound, CT and colonoscopy. Mucinous cystadenoma is the most common form of mucocele of the appendix. Diagnostic protocols are the same for benign appendix pathology. Treatment is surgical and type of surgery depends on the size of the mucocele. Mucoceles of the appendix are pathologies with a favorable prognosis when appropriate treatment is done.

Carcinoma escamoso: rara variedad de neoplasia colónica / Primary squamous cell carcinoma: a rare variety of colon cancer

Introducción: El cáncer colorrectal es la neoplasia más frecuente del tubo digestivo y la segunda en nuestro país en incidencia y mortalidad. El carcinoma de células escamosas de colon y recto es raro. La mayoría de los datos sobre ellos provienen de comunicaciones individuales y no se conoce mucho sobre su etiología, patogenia y pronóstico. Se presenta un caso de carcinoma escamoso primario localizado en ciego, con revisión de la literatura. Lugar de aplicación: Hospital de Alta Complejidad Presidente Juan Domingo Perón, Formosa, Argentina. Diseño: Presentación de caso clínico y revisión de la literatura. Pacientes y Métodos: Mujer de 67 años. Consulta en mayo de 2006 por anemia crónica y alteración del estado general. Presenta como antecedente anexohisterectomía por carcinoma epidermoide de cuello uterino con radioterapia adyuvante 10 años atrás. Al examen físico se palpa tumoración en fosa ilíaca derecha. La videocolonoscopía constata formación tumoral en ciego. Se toman biopsias, cuyo informe anatomopatológico revela carcinoma escamoso. Se realiza hemicolectomía derecha videolaparoscópica. Evoluciona sin complicaciones. Resultados: El protocolo de anatomía patológica informa: "Carcinoma escamoso moderadamente diferenciado infiltrante de ciego con metástasis en 12 de 14 ganglios resecados, con embolizaciones vasculares; estadificación patológica pT3-pN2-pMO / Dukes C2". Completó tratamiento adyuvante con 5 Fluorouracilo, Leucovorina y Oxaliplatino. Óbito por progresión de enfermedad a los 25 meses de seguimiento. Conclusiones: El carcinoma escamoso primario de colon y recto es una neoplasia sumamente infrecuente. La resección quirúrgica se presenta como la opción terapéutica más acertada. La efectividad de la adyuvancia no está comprobada. Su pronóstico parece ser peor que el de los adenocarcinomas para el mismo estadío.

Background: The colorectal cancer is more frequent neoplasia of the digestive tract and it is the second in our country in incidence and mortality. The squamous cell carcinoma of the colon and rectum is rare. Most of the data about them come from individual communications and is not know about its etiology, pathogenesis and prognosis. A primary squamous cell carcinoma of the colon case is submitted, it is located in the cecum with revision of the literature. Place of aplication: Hospital de Alta Complejidad Presidente Juan Domingo Perón, Formosa, Argentina. Design: Report of a case and revision of literature. Patients and Methods: Female patient of 67 years old. She consults in May of 2006 by chronic anemia and malaise. History of hysterectomy with bilateral salpingo-oophorectomy and adjuvant radiotherapy in epidermoid carcinoma of uterine cervix ten years ago. In the physical examination is felt a tumor in right iliac fosse. Videocolonoscopy shows tumor mass in cecum. Biopsies are taken, whose anatomopathologic report reveals squamous cell carcinoma. Results: A laparoscopic right colectomy is carried out. Patient evolves without complications. The protocol of anatomopathology report: "Moderately differenciated squamous cell carcinoma of the cecum with metastasis in 12 of 14 resects nodes with vascular embolizations; pathological staging pT3-pN2-pMO / Dukes C2". She completes adyuvant treatment with 5 Fluorouracil, Leucovorin and Oxaliplatin. She died at 25 months of follow up. Conclusions: Primary Squamous cell carcinoma of the colon and rectum is a rare malignancy. Surgical resection is presented like the wisest therapeutic option. Effectiveness of adjuvancy is not proven. Its prognostic seems to be worst than adenocarcinomas for the same phase.

Invaginación ileocecal como forma de presentación de linfoma no Hodgkin en un paciente con SIDA / Ileocolic intussusception due to a large B cell lymphoma in a patient with AIDS

La invaginación intestinal es poco frecuente en el adulto. Aquí se describe el caso de un paciente adulto con SIDA que desarrolló una invaginación ileocólica secundaria a un linfoma de células B localizado en el ciego. Los hallazgos quirúrgicos fueron: íleon libre de tumor, invaginado en el ciego infiltrado por la neoplasia. Se realizó la resección del hemicolon derecho debido a la tumoración localizada en el ciego, causante de la invaginación. Se revisó la literatura inglesa y española sobre este tema.

Adult intussusception is rare. Here, we describe a case of an AIDS adult patient who developed an ileocolic intussusception secondary to a large B cell lymphoma of the cecum. Surgical findings included the ileon free of the tumor and invaginated within the cecum with infiltrating neoplasm. Surgical treatment included the resection of the right hemicolon because of the tumor, located in the cecum, causing intussusception. The english and spanish literature is reviewed.

Synchronous carcinoid tumour of the small intestine and appendix in the same patient.

Carcinoid tumours have been reported in a wide range of organs but most frequently involve the gastrointestinal tract. Many of these carcinoid tumours are associated with metachronous and synchronous lesions of another histological type. Primary carcinoid tumours of the different organ in the same patient is rare. In this paper, the authors present a case with synchronous carcinoid tumour of the small intestine and appendix in the same patient.

Synchronous carcinoid tumour of the small intestine and appendix in the same patient / Tumor carcinoide sincrónico del intestino delgado y el apéndice en el mismo paciente

Carcinoid tumours have been reported in a wide range of organs but most frequently involve the gastrointestinal tract. Many of these carcinoid tumours are associated with metachronous and synchronous lesions of another histological type. Primary carcinoid tumours of the different organ in the same patient is rare. In this paper, the authors present a case with synchronous carcinoid tumour of the small intestine and appendix in the same patient.

Se han reportado tumores carcinoides en una amplia variedad de órganos, pero el lugar de detección más frecuente ha sido el tracto gastrointestinal. Muchos de estos tumores carcinoides se hallan asociados con lesiones metacrónicas y sincrónicas de otro tipo histológico. La presencia de tumores carcinoides primarios de un órgano diferente en el mismo paciente es rara. En este trabajo, los autores presentan un caso con tumores carcinoides sincrónicos del intestino delgado y el apéndice en el mismo paciente.

Primary Hodgkin's lymphoma of the caecum.

Extra-nodal Hodgkin's lymphoma (HL) represents 15% of all Hodgkin's lymphomas; the primary intestinal site accounts for 1% and with involvement of the ascending colon being rare. We present the case of a patient of 62 years of age diagnosed as having acute appendicitis. Anatomopathology on the excised appendectomy tissue indicated nodular lymphocytic predominant Hodgkin's lymphoma (NLPHL). The morphology indicated isolated L&H (lymphocytic or histiocytic) cells or in groups, surrounded by T lymphocytes, in an environment of germinal centres together with phenomena that would be interpreted as progressive transformation. Immunohistochemistry staining of the HL cells were positive for CD45, CD20, Bc16, EMA and MUM1 and negative for CD15 and CD30. No complementary treatment was administered. Following a literature search, the present case would appear to be the first of its kind.

Pseudotumor inflamatorio de Ciego como causa de abdomen agudo: Presentación de 3 casos / Inflammatory Pseudotumor of Blind as cause of sharp abdomen. Presentation of 3 cases

Se presentan 3 enfermos con tumores en fosa ilíaca derecha con cuadros abdominales mixtos oclusivos y peritoneales, donde se hizo necesario realizar hemicolectomía derecha por tumores que afectaban ciego e íleo terminal, sin hallar rastros de apéndice cecal, y habían sido procesos inflamatorios de la misma causa inicial de la enfermedad presente(AU)

3 patients with tumors on the right iliac fossa with mixed occlusive and peritoneal abdominal pictures, where it was necessary to perform right hemicolectomy due to tumors that affected the cecum and the terminal ileus, without finding signs of cecal appendix. Inflammatory processes of the same initial cause of the disease were also observed(AU)

[Simultaneous digestive tumors]. / Tumores digestivos simultáneos.

Synchronous and metachronous gastrointestinal tumors are well know entities, describing malignant tumors placed in the same organ, at the time of initial diagnosis or during the follow-up control. I would like to present two cases of malignant tumors placed in different organs of the digestive tube, at the time of diagnosis, coining the name simultaneous for these entities, stating laboratory finding and signo-symptomatologic interpretation difficulties, and proposing endoscopic approach as a valid diagnostic method.

Manifestaciones poco frecuentes de un síndrome carcinoide / Unfrequent manifestations of a carcinoid syndrome

Este trabajo estará destinado a mostrar las manifestaciones poco comues de un sindrome carcinoide de ciego. En este caso particular, la paciente presentó no sólo las clásicas manifestaciones del síndrome carcinoide, sino que también evidenció en el transcurso de su enfermedad otras menos frecuentes, lo que motivó su presentación. Se escriben así manifestaciones cutáneas, oftalmológicas, neurológicas, articulares. Se hará mención a las dificultades diagnósticas en este tipo de tumores así como a la demora en establecer un diagnóstico certero. Asimismo se discutirán las distintas opciones terapéuticas para estos síndromes y la evolución de este caso en particular(AU)

Manifestaciones poco frecuentes de un síndrome carcinoide / Unfrequent manifestations of a carcinoid syndrome

Este trabajo estará destinado a mostrar las manifestaciones poco comues de un sindrome carcinoide de ciego. En este caso particular, la paciente presentó no sólo las clásicas manifestaciones del síndrome carcinoide, sino que también evidenció en el transcurso de su enfermedad otras menos frecuentes, lo que motivó su presentación. Se escriben así manifestaciones cutáneas, oftalmológicas, neurológicas, articulares. Se hará mención a las dificultades diagnósticas en este tipo de tumores así como a la demora en establecer un diagnóstico certero. Asimismo se discutirán las distintas opciones terapéuticas para estos síndromes y la evolución de este caso en particular