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1.
Chirurgia (Bucur) ; 115(3): 404-409, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614297

RESUMO

Introduction: The GIST tumors are very rare entities ( 1% of all tumors). They originate in the Cajal interstitial cells, which are part of the autonomic nervous system of the intestine. Their most common location is the stomach, followed by the small intestine. The aim of this paper is to present a very rare case of perforated ileal GIST, associated with Meckel diverticulum. Case report: A 71 years old patient with comorbidities is admitted in emergency for symptoms and signs of acute surgical abdomen. The exploratory laparotomy reveals generalized acute peritonitis due to perforated ileal tumor and Meckel's diverticulum. A segmental enterectomy is performed, with favorable postoperative evolution. The histological examination of the resection piece shows the appearance of GIST, confirmed immunohistochemically. Conclusions: The GIST tumors of the small intestine are unusual tumors and the spontaneous perforation and life-threatening hemorrhage are a rarity. The main treatment for this form of GIST is the resection, with a favorable clinical outcome.


Assuntos
Abdome Agudo , Tumores do Estroma Gastrointestinal , Neoplasias do Íleo/complicações , Perfuração Intestinal , Divertículo Ileal , Idoso , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neoplasias do Íleo/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(25): e20820, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569231

RESUMO

INTRODUCTION: Interferon alpha (IFNα) has been used for a long time in patients with functionally active neuroendocrine tumors (NET). However, due to the unfavorable toxicity profile of interferon, the perceived limited efficacy as well as the development of novel substances, IFNα is only used sparingly in the treatment of NET to date. PATIENTS CONCERNS AND DIAGNOSIS: We describe the case of a 63-year-old male patient with highly differentiated, functional NET of the ileum and synchronous liver metastasis. INTERVENTIONS: After failure of classical therapies including dose-intensified somatostatin analog treatment and palliative primary tumor resection, a therapy with pegylated IFNα2a (135 µg/wk) was initiated. Following this treatment, the patient fully recovered from signs of hypersecretion and demonstrated an impressive tumor response. OUTCOMES: Thirty months after initiating IFNα, the patient is still free of clinical symptoms and shows a sustained tumor response. Notably, no relevant side effects were observed. CONCLUSION: Our case report supports the use of IFNα in patients with functional NET refractory to classical treatments.


Assuntos
Neoplasias do Íleo/tratamento farmacológico , Interferon alfa-2/uso terapêutico , Interferon-alfa/uso terapêutico , Tumores Neuroendócrinos/tratamento farmacológico , Polietilenoglicóis/uso terapêutico , Humanos , Neoplasias do Íleo/patologia , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/patologia , Proteínas Recombinantes/uso terapêutico , Falha de Tratamento , Resultado do Tratamento
3.
J Surg Oncol ; 122(2): 204-211, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32291778

RESUMO

BACKGROUND AND OBJECTIVES: We classified the extent of mesenteric mass (MM) involvement that predicts challenging mesenteric lymph node dissection (mLND) by minimally invasive surgery (MIS) for ileal neuroendocrine tumors (i-NETs). METHODS: Patients who underwent surgery for i-NETs were retrospectively reviewed. MM involvement was classified as region-0: no MM; region-1: >2 cm from the origins of the ileocolic artery/vein; region-2: ≤2 cm from the origins; and region-3: more proximal superior mesenteric artery/vein. Logistic regression analysis was used to evaluate the predictive value of MM regions for gross positive mesenteric margin (mR2) and/or conversion among the MIS cohort. The open surgery cohort was used as a reference for mR2 rates. RESULTS: Of 108 patients, 83 patients (77%) underwent MIS. MMs in region-2 and region-3 were independent risk factors for mR2 and/or conversion (odds ratio [95% confidence interval]: 4.25 [1.17-16.4] and 8.51 × 107 [11.0-], respectively, against regions-0 and 1]. mR2 rates of MIS and open surgery cohorts per region did not differ significantly (4% and 7% for regions-0 and 1; 17% and 25% for region-2; and 100% and 83% for region-3). CONCLUSIONS: The novel stratification of MM regions was predictive of challenging mLND by MIS. Surgeons should have a low threshold for conversion for MMs in proximal regions.


Assuntos
Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Linfonodos/patologia , Linfonodos/cirurgia , Mesentério/patologia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Estudos de Coortes , Humanos , Excisão de Linfonodo , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos
4.
J Surg Res ; 252: 116-124, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32278965

RESUMO

BACKGROUND: Proximal (duodenal) small bowel adenocarcinomas have a worse prognosis than distal (jejuno-ileal) tumors, but differences in patient, tumor, and treatment factors between locations remain unclear. METHODS: Patients in the National Cancer Database with surgically resected pathologic stage I-IV small bowel adenocarcinomas between 2004 and 2015 were analyzed. Clinical stage IV patients were excluded. RESULTS: Proximal tumors (n = 3767) were more likely to be higher grade (OR 1.52, CI 1.22-1.85 for moderately; OR 1.83, CI 1.49-2.33 for poorly differentiated, P < 0.01 for both) and have positive lymph nodes (OR 2.04, CI 1.30-3.23, P < 0.01), while distal tumors (n = 3252) were likely to be larger (OR 1.31, CI 1.07-1.60 for size > 5 cm, P < 0.01). Proximal tumors were associated with worse overall survival (OS) and stage-specific survival compared with distal tumors (all P < 0.01). Cox regression analysis of the entire cohort showed worse survival with community versus academic cancer programs, higher comorbidity scores, pathologic stage IV, poorly differentiated histology, positive nodal or margin status, and proximal location, while female gender, larger tumor size, and chemotherapy predicted better survival. On separate Cox regression analyses of each location, neoadjuvant chemotherapy was associated with better OS in the proximal cohort (HR 0.70, CI 0.55-0.88, P < 0.01), while adjuvant chemotherapy was associated with better OS for both proximal (HR 0.49, CI 0.42-0.57, P < 0.01) and distal tumors (HR 0.68, CI 0.57-0.81, P < 0.01). CONCLUSIONS: Proximal small bowel adenocarcinomas are associated with worse overall and stage-specific survival. This may be due to tumor biologic differences as proximal tumors were more likely to have higher grade. Future studies should further investigate differences between proximal and distal tumors to guide targeted treatment algorithms.


Assuntos
Adenocarcinoma/mortalidade , Neoplasias Duodenais/mortalidade , Neoplasias do Íleo/mortalidade , Neoplasias do Jejuno/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Idoso , Quimiorradioterapia Adjuvante , Neoplasias Duodenais/patologia , Neoplasias Duodenais/terapia , Duodeno/patologia , Duodeno/cirurgia , Feminino , Humanos , Neoplasias do Íleo/patologia , Neoplasias do Íleo/terapia , Íleo/patologia , Íleo/cirurgia , Neoplasias do Jejuno/patologia , Neoplasias do Jejuno/terapia , Jejuno/patologia , Jejuno/cirurgia , Estimativa de Kaplan-Meier , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Terapia Neoadjuvante , Gradação de Tumores , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Taxa de Sobrevida , Resultado do Tratamento
5.
BMC Med Genet ; 21(1): 76, 2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-32272879

RESUMO

BACKGROUND: Despite recent findings that epithelial cell adhesion molecule (EPCAM) deletions can cause Lynch syndrome (LS), its clinical characteristics are still unknown. We present the first case of ileum cancer in a patient with germline EPCAM gene deletion, which was discovered during ovarian tumor surgery. CASE PRESENTATION: A 59-year-old woman presented with a history of colon cancer occurring at 38 and 55 years old. Five of her siblings had a history of colon cancer, and an elder sister had confirmed LS. As imaging examination revealed an ovarian tumor, and we performed hysterectomy and bilateral salpingo-oophorectomy. Careful observation during surgery revealed a cherry-sized tumor in the ileum, prompting partial ileal resection. Pathological examination showed the ovarian tumor to be a metastasis of ileum cancer. Genetic testing with blood-relative information using multiplex ligation-dependent probe amplification showed EPCAM exons 8 and 9 deletions, confirming LS. The patient received adjuvant chemotherapy with CAPOX (capecitabine and oxaliplatin) and has remained disease-free for 24 months. CONCLUSIONS: We were fortunate to identify ileum cancer that would have been difficult to find preoperatively through careful observation during ovarian tumor surgery and successfully treated the patient by using surgical resection and CAPOX chemotherapy. When treating patients with hereditary cancer syndromes including LS, we should keep all associated cancers in mind.


Assuntos
Adenocarcinoma , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Molécula de Adesão da Célula Epitelial/genética , Neoplasias do Íleo , Neoplasias Ovarianas , Ovariectomia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/genética , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Capecitabina/administração & dosagem , Neoplasias Colorretais Hereditárias sem Polipose/tratamento farmacológico , Neoplasias Colorretais Hereditárias sem Polipose/genética , Neoplasias Colorretais Hereditárias sem Polipose/cirurgia , Terapia Combinada , Feminino , Mutação em Linhagem Germinativa , Humanos , Neoplasias do Íleo/tratamento farmacológico , Neoplasias do Íleo/genética , Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Pessoa de Meia-Idade , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/secundário , Neoplasias Ovarianas/cirurgia , Oxaliplatina/administração & dosagem , Linhagem , Deleção de Sequência , Resultado do Tratamento
6.
Medicina (B Aires) ; 80(1): 81-83, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32044744

RESUMO

Wiskott-Aldrich syndrome is a rare X chromosome-linked primary immunodeficiency syndrome associated with an increased incidence of infections, autoimmune disorders and neoplasms. We present the case of a 41-year-old man with a diagnosis of Wiskott-Aldrich syndrome with ileitis as a form of presentation of a lymphoproliferative syndrome. The ileitis, in the context of the patient, represents a clinical challenge given the large number of differential diagnoses (inflammatory bowel disease, infections, neoplasms and lymphoproliferative diseases), so it usually requires anatomopathological diagnosis and particular considerations regarding the subsequent specific treatment.


Assuntos
Neoplasias do Íleo/patologia , Ileíte/patologia , Linfoma/patologia , Síndrome de Wiskott-Aldrich/patologia , Adulto , Biópsia , Diagnóstico Diferencial , Humanos , Neoplasias do Íleo/diagnóstico , Ileíte/diagnóstico , Imuno-Histoquímica , Linfoma/diagnóstico , Masculino , Síndrome de Wiskott-Aldrich/diagnóstico
8.
Medicine (Baltimore) ; 98(49): e18103, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804320

RESUMO

INTRODUCTION: Benign prostatic hyperplasia, bladder outlet obstruction, and overactive bladder are major causes of lower urinary tract symptoms (LUTS). Tumor compression of the urinary bladder resulting in LUTS was clinically observed. Gastrointestinal stromal tumors (GISTs) presenting with LUTS have not been reported before. Herein, we report a patient with extraluminal GIST of the ileum who had LUTS without gastrointestinal symptoms during the clinical course. PATIENT CONCERNS: A 68-year-old man visited the genitourinary outpatient department because of frequent urination with mild dysuria. He also complained of poor appetite, fatigue, and body weight loss of 10 kg over 6 months. A large presacral solid mass lesion compressing the bladder and surrounded by the bowel with gas content was identified through abdominal computed tomography. DIAGNOSIS: GIST of the ileum with mesenteric invasion was revealed by pathological examination. INTERVENTIONS: Exploratory laparotomy with removal of the pelvic tumor and segmental resection of the ileum was performed. OUTCOMES: Now, he received adjuvant imatinib target therapy for 1 year with stable condition. CONCLUSION: Extravesical compression or invasion of the urinary bladder by a pelvic mass lesion is common but is rarely accompanied by GISTs of the ileum. Specific findings identified through imaging should alert the surgeon to this specific entity and prepare thoroughly before surgical intervention.


Assuntos
Tumores do Estroma Gastrointestinal/patologia , Neoplasias do Íleo/patologia , Idoso , Quimioterapia Adjuvante , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/cirurgia , Masculino , Incontinência Urinária/etiologia
9.
Pan Afr Med J ; 33: 197, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692688

RESUMO

Gastrointestinal bleedings caused by small intestinal tumors are rare and difficult to diagnose because they are not easy to access to the conventional endoscopy. We report two cases, one of them from proximal jejunum and the other one from ileal intestine complicated by intussusception. The two cases were admitted in the emergency department for hematochezia and melena, the diagnosis was established by enhanced helical computed tomography angiography.


Assuntos
Hemorragia Gastrointestinal/etiologia , Neoplasias do Íleo/complicações , Neoplasias do Jejuno/complicações , Idoso , Angiografia por Tomografia Computadorizada , Hemorragia Gastrointestinal/diagnóstico , Humanos , Neoplasias do Íleo/diagnóstico , Intussuscepção/complicações , Intussuscepção/diagnóstico , Neoplasias do Jejuno/diagnóstico , Masculino
10.
Hinyokika Kiyo ; 65(9): 369-375, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31697879

RESUMO

A 76-year-old woman presented with temporary right back pain and renal dysfunction. She had undergone ileal ureter interposition for right ureteral resection due to retroperitoneal liposarcoma about forty years ago. Abdominal computed tomographic (CT) scan showed right hydronephrosis and a stenosis in the middle of the ileal ureter. The symptoms were relieved, and the patient was followed. Six months later, however, a contrast enhanced lesion was newly observed at the stenosis of the ileal ureter, and nineteen months later, right ovarian tumor and peritoneal dissemination were subsequently observed. Aiming at diagnosis and cytoreduction, right nephroureterectomy and bilateral oophorectomy were performed. Histopathological findings of the resected tumors showed common characteristics of infiltrating and proliferating adenocarcinoma. Immunohistochemistry findings showed that Cytokeratin 7 and Cytokeratin 20 stained positive. On the other hand, Mucin 2 and Special AT-rich sequence-binding protein 2 were not found. The histopathological diagnosis was metastatic mucinous adenocarcinoma of the ovary with ileal ureter and a wide peritoneal dissemination. The patient rejected adjuvant chemotherapy and a new lesion was found in the pelvic fourmonths afterthe surgery.


Assuntos
Adenocarcinoma Mucinoso , Neoplasias do Íleo , Neoplasias Ovarianas , Ureter , Idoso , Feminino , Humanos , Íleo
11.
Anticancer Res ; 39(11): 6413-6416, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704875

RESUMO

BACKGROUND/AIM: The aim of this study was to present the clinical characteristics, natural history and survival outcomes of primary gastrointestinal non-Hodgkin lymphomas (PGINHL) in the pediatric population. PATIENTS AND METHODS: Surveillance, Epidemiology, and End Results (SEER) database was queried for patients aged 0 to 19 years with PGINHL between 1973 and 2014. RESULTS: A total of 452 cases were identified [mean age 11.0 (±5.1)] years, whites 84.1%, males (76.5%). The majority of tumors were noted in the small bowel (SB) (47.6%), followed by large bowel (LB) (28.5%) and the stomach (10.0%). Overall, the most common histological subtype was Burkitt lymphoma (51.8%), followed by diffuse large B-cell lymphoma (DLBCL) (26.1%). Mean overall survival (OS) of the entire cohort was 33,33 years with a 5-yr, 10-yr and 30-yr survival rate of 86%, 86% and 79%, respectively. Large bowel tumors had the best long-term survival rates whereas; gastric tumors had the worst with 30-yr survival rate 84% and 74%, respectively. Overall, 328 (72.6%) patients received surgery. No significant survival difference was noted between patients who underwent surgery and those who did not. CONCLUSION: This study presents the largest dataset of pediatric PGINHL and describes the clinical features and outcomes of these patients in addition to summarizing the literature.


Assuntos
Neoplasias Gastrointestinais , Linfoma não Hodgkin , Adolescente , Linfoma de Burkitt/mortalidade , Linfoma de Burkitt/patologia , Linfoma de Burkitt/cirurgia , Neoplasias do Ceco/mortalidade , Neoplasias do Ceco/patologia , Neoplasias do Ceco/cirurgia , Criança , Pré-Escolar , Feminino , Neoplasias Gastrointestinais/mortalidade , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/cirurgia , Humanos , Neoplasias do Íleo/mortalidade , Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Lactente , Recém-Nascido , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/cirurgia , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/cirurgia , Masculino , Programa de SEER , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida , Adulto Jovem
12.
Am Surg ; 85(10): 1125-1128, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657307

RESUMO

Neuroendocrine tumors (NETs) are the most common malignancy arising in Meckel's diverticula (MDs). To date, there are no large series characterizing these tumors. The National Cancer Database was queried for patients with MD NETs (n = 162) from 2004 to 2014. Patient and tumor characteristics as well as outcomes were analyzed. MD NETs were more common in men (72.8%) at a median age of 62 years; 95.1 per cent of patients were white. All patients underwent surgery. Clinical M0 disease was present in 97.4 per cent of patients, and 88.2 per cent of tumors were well differentiated. Lymphovascular invasion was present in 13.2 per cent. Most (60.4%) tumors were less than 10 mm. Lymphadenectomy was performed in 32.9 per cent of patients, with 52.1 per cent of these found to have metastatic lymph node disease. Although most MD NETs are well differentiated, smaller than 10 mm, and do not have lymphovascular invasion, lymph node metastases are commonly found, suggesting that mesenteric lymphadenectomy with adequate resection of the small bowel may be necessary for adequate staging and disease clearance.


Assuntos
Neoplasias do Íleo/etiologia , Divertículo Ileal/complicações , Tumores Neuroendócrinos/etiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias do Íleo/epidemiologia , Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Estimativa de Kaplan-Meier , Excisão de Linfonodo/estatística & dados numéricos , Metástase Linfática , Masculino , Divertículo Ileal/epidemiologia , Pessoa de Meia-Idade , Tumores Neuroendócrinos/epidemiologia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Programa de SEER/estatística & dados numéricos , Distribuição por Sexo , Carga Tumoral
13.
J Surg Oncol ; 120(8): 1311-1317, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31613999

RESUMO

BACKGROUND AND OBJECTIVES: Ileal neuroendocrine tumors (i-NETs) frequently metastasize to mesenteric lymph nodes and the liver. Regional lymphadenopathy is associated with desmoplasia of the mesentery forming a large mesenteric mass (LMM). Although the latest American Joint Committee on Cancer TNM staging (8th edition) defined LMM >2 cm as N2, the prognostic impact of LMM is ill-defined. We evaluated whether LMM is prognostic for patients with i-NETs. METHODS: This single-institution, retrospective cohort study included 106 patients who underwent resection of i-NETs between 2007 and 2018. Overall survival (OS) and liver progression-free survival (LPFS) were compared between patients with and without LMM. RESULTS: LMM was present in 66 patients (62%) and was not associated with the presence or absence of liver metastasis (P = .969) or the extent of liver involvement (P = .938). OS and LPFS differed significantly between patients with and without LMM (5-year OS rates of 64.8% and 92.9%, respectively, P = .011; 3-year LPFS rates of 45.3% and 67.5%, respectively, P = .025). In multivariate analysis, LMM was an independent prognostic factor for both OS (hazard ratio: 4.69, 95% confidence interval: 1.63-17.6) and LPFS (1.99, 1.08-3.88). CONCLUSION: LMM >2 cm is prognostic for OS and LPFS and represents aggressive tumor biology.


Assuntos
Neoplasias do Íleo/mortalidade , Neoplasias do Íleo/patologia , Linfonodos/patologia , Mesentério/patologia , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/patologia , Idoso , Estudos de Coortes , Feminino , Humanos , Neoplasias do Íleo/cirurgia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/cirurgia , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos
14.
Cir Cir ; 87(S1): 17-21, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501629

RESUMO

Introduction: Patients with inflammatory bowel disease (IBD) have a higher risk of developing gastrointestinal tumors, the adenocarcinoma is the most frequently associated, and neuroendocrine tumor (NET) the most rare. Clinical cases: We present two patients, one with Crohn's disease and the other with ulcerative colitis, who present nonspecific symptoms, and after resection of an intestinal lesion, a gastrointestinal NET (GINET) is diagnosed. Discussion and conclusion: The GINET have an insidious clinic and these can be confused with those of the IBD. There could be an association between both pathologies; an important role of the chronic intestinal inflammatory process is suggested. The best treatment for GINET is the resection.


Assuntos
Colite Ulcerativa/complicações , Doença de Crohn/complicações , Neoplasias do Íleo/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Neoplasias Retais/diagnóstico , Idoso , Carcinoma de Células Renais , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/cirurgia , Pólipos do Colo/complicações , Pólipos do Colo/tratamento farmacológico , Colonoscopia , Doença de Crohn/tratamento farmacológico , Doença de Crohn/cirurgia , Diagnóstico Tardio , Diagnóstico Diferencial , Suscetibilidade a Doenças , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/cirurgia , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Achados Incidentais , Inflamação , Neoplasias Renais , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/complicações , Segunda Neoplasia Primária/diagnóstico , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/cirurgia , Neoplasias Retais/complicações , Neoplasias Retais/cirurgia
15.
BMJ Case Rep ; 12(9)2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511264

RESUMO

We report on a clinical case with haemorrhagic small bowel metastases in a malignant melanoma patient with anaemia, diagnosed using small bowel video capsule endoscopy (VCE). A 67-year-old male patient with a previous diagnosis of malignant melanoma presented with anaemia and vertigo on admission. The standard diagnostic protocol for gastrointestinal (GI) bleeding investigation including a gastroscopy, colonoscopy and small bowel capsule endoscopy, as well as abdominal sonography and a restaging protocol including chest-abdomen-pelvis CT (CAP-CT), echocardiography and ECG was applied. Gastroscopy and colonoscopy were not conclusive in determining the bleeding source. VCE provided evidence for numerous haemorrhagic small bowel metastases. The CAP-CT was unremarkable for small bowel findings. Due to a diffuse metastatic disease diagnosed in heart, brain, liver, spleen and bone metastasis, the patient was treated in a conservative/palliative manner. VCE can provide precious information about GI bleeding of unknown origin when classical diagnostic methods are non-conclusive.


Assuntos
Hemorragia Gastrointestinal/etiologia , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Jejuno/diagnóstico por imagem , Melanoma/complicações , Melanoma/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Idoso , Anemia/etiologia , Endoscopia por Cápsula , Evolução Fatal , Humanos , Neoplasias do Íleo/secundário , Neoplasias do Jejuno/secundário , Masculino , Melanoma/secundário
16.
BMJ Case Rep ; 12(7)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31371335

RESUMO

A 65-year-old woman with a history of proctocolectomy and end ileostomy for ulcerative colitis was referred to our clinic with a slowly growing mass around her ileostomy. She did not report any systemic symptoms. On examination, an exophytic mass was observed around her ileostomy and hard lymph nodes palpated in her groins bilaterally. Punch biopsy of the lesion established a diagnosis of invasive melanoma. Positron emission tomography revealed regional metastatic lymphadenopathy in the right axilla and both groins. There was no evidence of distant metastatic disease. The patient then underwent wide local excision of her ileostomy with bowel resection and ileostomy re-siting, bilateral complete ilioinguinal lymphadenectomy and a right Level III axillary dissection. She is doing well postoperatively and receiving adjuvant systemic therapy with BRAF and MEK inhibitors, now 17 months later with no signs of recurrent disease.


Assuntos
Colite Ulcerativa/cirurgia , Neoplasias do Íleo/etiologia , Ileostomia/efeitos adversos , Melanoma/etiologia , Complicações Pós-Operatórias/etiologia , Idoso , Humanos , Masculino
18.
Medicine (Baltimore) ; 98(27): e16305, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277169

RESUMO

RATIONALE: Intestinal ganglioneuromatosis (IGNM) is a rare disease, defined by an abnormal proliferation of ganglion cells, nerve fibers and Schwann cells in the enteric nerve system. PATIENT CONCERNS: A 54-year-old woman presented with a one-year history of recurrent episodes of hypogastric pain, with vomiting, nausea, melena, and weight loss of 10 kg in recent 5 months. DIAGNOSES: The patient was diagnosed as a diffuse IGNM by pathological examination. INTERVENTIONS: A complete excision of the tumor was performed. OUTCOMES: On follow-up after 26 months, the patient was asymptomatic without complications. LESSONS: This report showed a rare case of diffuse IGNM not associated with NF1 or MEN2b. Preoperative radiological examination suggested an intestinal GIST, yet the final diagnosis of diffuse IGNM was made according to the pathological examination of the resected specimen. Although the prevalence of ganglioneuromatosis is low, this condition should be considered in the differential diagnosis of intestinal mass in adults.


Assuntos
Ganglioneuroma/diagnóstico , Tumores do Estroma Gastrointestinal/diagnóstico , Neoplasias do Íleo/diagnóstico , Diagnóstico Diferencial , Feminino , Ganglioneuroma/cirurgia , Humanos , Neoplasias do Íleo/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
19.
Clin Nucl Med ; 44(9): e532-e534, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31274557

RESUMO

Metastasis to the breast is a rare occurrence and constitutes less than 2% of all breast tumors. Similarly, ovarian metastases from neuroendocrine tumors are also uncommon, and if the adnexal masses are bilateral, then the chances of it being metastatic rather than being primary range from 88% to 94%. We present a case of 61-year-old woman who in the course of workup for abdominal pain and diarrhea was eventually diagnosed as ileal neuroendocrine tumor with breast, ovarian, and lymph nodal metastases on Ga-DOTANOC PET/CT scan.


Assuntos
Neoplasias da Mama/secundário , Neoplasias do Íleo/patologia , Tumores Neuroendócrinos/patologia , Compostos Organometálicos , Neoplasias Ovarianas/secundário , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico por imagem , Probabilidade
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