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1.
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
2.
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
3.
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
4.
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
5.
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
6.
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
7.
Ann Ital Chir ; 82019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31112522

RESUMO

INTRODUCTION: Adult intussusception is a rare cause of bowel obstruction with atypical presentation. It can be associated with primary or secondary intestinal tumors and, rarely, with lipomatous masses. CASE REPORT: We report the case of a 69-year old man presenting with a history of gastrointestinal bleeding and anemia. Upper and lower endoscopies were negative for bleeding. On abdominal contrast enhanced computerized tomography (CT) scan, a trans-omental hernia in the right lower abdominal quadrant was diagnosed with no active bleeding or evidence of tumor. On exploratory laparoscopy we detected an ileo-ileal intussusception caused by a submucosal mass in the distal ileum, which was reduced and we then performed a segmental resection of the involved small bowel tract. The patient fully recovered by postoperative day 3 when he was discharged home. Final pathology confirmed an ileal lipoma. CONCLUSION: Ileal intussusception caused by lipoma is a rare condition, which can be diagnosed with endoscopy, barium enema, and abdominal ultrasound or CT scanning, but preoperative diagnosis may be difficult. The treatment of choice is the reduction of the intussusception and the resection (laparoscopic or open) of the involved tract. KEY WORDS: Intussusception, Lipoma, Ileum, Laparoscopy, Bleeding.


Assuntos
Doenças do Íleo/cirurgia , Neoplasias do Íleo/cirurgia , Intussuscepção/cirurgia , Laparoscopia , Lipoma/cirurgia , Idoso , Hemorragia Gastrointestinal/etiologia , Humanos , Doenças do Íleo/etiologia , Neoplasias do Íleo/complicações , Intussuscepção/etiologia , Lipoma/complicações , Masculino
8.
Pediatr Surg Int ; 35(8): 879-885, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31139892

RESUMO

BACKGROUND: Most cases of intussusception in children are idiopathic. Rarely, a malignant disease such as intestinal lymphoma may cause intussusception. Due to dramatic changes of expected outcome with chemotherapy regime alone, the surgical management of patients with intestinal lymphoma presenting with intussusception has to be reevaluated. METHODS: Retrospective chart review from May 2011 to February 2017. We included all patients with intestinal lymphoma presenting with intussusception. RESULTS: We found five patients with a mean age of 6.4 years (range 3-16). The most common presenting symptom was abdominal pain for several weeks which had acutely worsened. In all but one patient an ultrasound before pneumatic or hydrostatic reduction showed a finding suspicious of a pathological lead-point. Pneumatic or hydrostatic reduction was attempted in all patients, no complications were noted. In one patient reduction was not successful. Recurrence after reduction occurred in two patients. Two patients needed surgery, three had a percutaneous ultrasound-guided biopsy for diagnostic purposes. All patients had aggressive mature B cell non-Hodgkin lymphoma. CONCLUSION: A high index of suspicion for the presence of a pathological lead-point in children older than 4 years and children with recurrent intussusception is necessary in patients presenting with intussusception. Malignant, highly aggressive B cell non-Hodgkin lymphoma, although rare, must actively be searched for. Pneumatic or hydrostatic reduction should remain the first line treatment in most cases.


Assuntos
Neoplasias do Íleo/complicações , Intussuscepção/etiologia , Laparotomia/métodos , Linfoma/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Pressão Hidrostática , Neoplasias do Íleo/diagnóstico , Neoplasias do Íleo/cirurgia , Biópsia Guiada por Imagem , Intussuscepção/diagnóstico , Intussuscepção/terapia , Linfoma/diagnóstico , Linfoma/cirurgia , Masculino , Estudos Retrospectivos , Ultrassonografia
9.
BMJ Case Rep ; 12(5)2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31126929

RESUMO

Intramesosigmoid hernias are a rare cause of small bowel obstruction. Here, we present such a case with learning points derived from diagnostic dilemma, shared decision making in consent and the management of a rare cause of a common surgical emergency.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias do Íleo/diagnóstico , Obstrução Intestinal/diagnóstico , Neoplasias Gástricas/diagnóstico , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Idoso , Diagnóstico Diferencial , Humanos , Neoplasias do Íleo/secundário , Neoplasias do Íleo/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Masculino , Metástase Neoplásica , Neoplasias Gástricas/patologia
10.
Medicine (Baltimore) ; 98(20): e15714, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096523

RESUMO

RATIONALE: Kaposi sarcoma (KS) is a mesenchymal neoplasm associated with human herpes virus-8. It is often found in patients with primary or secondary immunodeficiency. An iatrogenic form of KS is detectable in patients who have received immunosuppressive therapy. To date, there are few reported cases of patients with KS treated with immunosuppressants for inflammatory bowel disease. PATIENT CONCERNS: We report the case of a 45-year-old young woman with abdominal pain, episodic diarrhea and a mild weight loss. The patient was treated with immunosuppressive therapy for a parietal thickening of the terminal ileum, wrongly diagnosed as Crohn disease. After 9 months after the beginning of antitumor necrosis factor-α, the patient was admitted for obstructive symptoms. A computed tomography suspected neoplasia of ileocecal region. The patient underwent an uneventful ileocecal surgical resection. DIAGNOSES: The histopathology showed endometriosis of the ileal wall and an irrefutable diagnosis of KS by immunohistochemistry-positive staining for human herpes virus-8. INTERVENTIONS AND OUTCOMES: The patient underwent surgical resection and is disease free at 6 years follow-up. LESSONS: This case underlines the interaction of immunosuppressive therapy with the possible consequent development of visceral KS.


Assuntos
Doença de Crohn/tratamento farmacológico , Neoplasias do Íleo/diagnóstico por imagem , Imunossupressores/efeitos adversos , Obstrução Intestinal/induzido quimicamente , Sarcoma de Kaposi/diagnóstico por imagem , Erros de Diagnóstico , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Humanos , Doença Iatrogênica , Neoplasias do Íleo/cirurgia , Obstrução Intestinal/etiologia , Pessoa de Meia-Idade , Sarcoma de Kaposi/cirurgia , Resultado do Tratamento
11.
J Pak Med Assoc ; 69(4): 580-583, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31000867

RESUMO

Small bowel cancers are a rare group of cancers of the gastrointestinal tract. Adenocarcinoma of ileum is an even rarer pathology to come across. We had a case of small bowel adenocarcinoma (SBA) who presented with recurrent abdominal pain and vomiting to different local hospitals. Abdominal ultrasound showed dilated bowel 4.7cm in size with sluggish movement. Patient was treated symptomatically for 3 months with poor outcome. Then patient presented in our hospital as an e m e r g e n c y w i t h i n t e s t i n a l o b s t r u c t i o n a n dhaemodynamic instability. Exploratory laprotomy was performed after initial optimization. A hard stricture was found in ileum. The segment of ileum with suitable margins was resected and loop ileostomy was performed. Histopathology findings indicated an adenocarcinoma of ileum. Our rationale to report this case is to raise awareness among physicians about SBA in patients with vague abdominal pain and vomiting, and the fact that negligence in diagnosing this rare cancer can turn it into a surgical emergency which increases the morbidity and mortality in patients.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias do Íleo/diagnóstico , Obstrução Intestinal/diagnóstico , Dor Abdominal/etiologia , Adenocarcinoma/complicações , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Erros de Diagnóstico , Emergências , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Ileostomia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Vômito/etiologia , Perda de Peso
12.
BMJ Case Rep ; 12(3)2019 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-30878964

RESUMO

Carcinoid tumours have the ability to secrete various peptides and bioamines that lead to carcinoid syndrome manifested as cutaneous flushing, diarrhoea, bronchial constriction and cardiac involvement. The deficiencies of vitamins D and B12 have previously been reported in patients with carcinoid tumours presumably due to chronic diarrhoea associated with the carcinoid syndrome. Herein, we chronicle the case of a patient with opioid use disorder who presented with small bowel obstruction that was found to be caused by a midgut carcinoid tumour. Laboratory studies revealed deficiencies of vitamins D and B12 even though he denied diarrhoea and had no other aetiology of deficiencies of these vitamins. Additionally, this paper presents a review of the published medical literature pertaining to clinical features, diagnostic investigations and treatment of intestinal carcinoid tumours and explores possible explanations for the observed deficiencies in these patients.


Assuntos
Carcinoma Neuroendócrino/patologia , Neoplasias do Íleo/patologia , Carcinoma Neuroendócrino/complicações , Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Neuroendócrino/cirurgia , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/cirurgia , Laparotomia , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/complicações , Deficiência de Vitamina B 12/complicações , Deficiência de Vitamina B 12/diagnóstico , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/diagnóstico
14.
Acta Chir Belg ; 119(5): 277-281, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30259784

RESUMO

Introduction: Management of asymptomatic Meckel's diverticulum (MD) incidentally discovered in adults remains controversial. The aim of this study was to determine if incidental diverticula should be removed. Materials and methods: We reviewed a consecutive series of patients surgically managed from January 1994 to December 2016. Patients were divided into two groups according to symptomatic or asymptomatic diverticula, and characteristics were compared. Results: The study included 66 patients: 30 in the symptomatic group (45%) and 36 in the incidental group (55%). We found 12 females (18.2%), and the ratio male:female was higher in the symptomatic group (14:1 vs. 2.6:1). Patients in the symptomatic group were significantly younger: 41.7 ± 18.1 vs. 54.7 ± 19.8 years (p = .007). MD in the symptomatic group tended to be longer (3.8 ± 1.9 vs. 2.6 ± 0.9 cm; p = .003). A MD-associated malignancy was present in three patients (4.5%), all neuroendocrine tumours. Major postoperative complications occurred in 6.6% of symptomatic patients and 0% within the incidental group, without specific morbidity related to prophylactic surgery. No mortality was observed. Conclusion: Resection of incidentally found Meckel's diverticulum can be made because of benefits outweigh the risks in this high-risk area for cancer.


Assuntos
Divertículo Ileal/cirurgia , Adulto , Idoso , Feminino , Humanos , Neoplasias do Íleo/etiologia , Neoplasias do Íleo/cirurgia , Achados Incidentais , Masculino , Divertículo Ileal/complicações , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
15.
Medicine (Baltimore) ; 97(51): e13351, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30572439

RESUMO

RATIONALE: Calcifying fibrous tumors ("CFT") are recognized as extremely rare mesenchymal tumors with benign biological behavior and low rates of recurrence are seen after removal. The first case of a CFT was reported in 1988 as a possibly inflammatory triggered pseudotumor in deep soft tissue of children. Histologically, the tumor is typically composed of dense hyalinized collagen with paucicellular infiltration of lymphocytes and fibroblasts as well as psammomatous or dystrophic calcifications. It can affect soft tissue in very different anatomical locations, also intrathoracic and intra-abdominal, mimicking various different diagnoses. The etiology is understood to be unclear. Asymptomatic CFTs can be found incidentally on medical images. PATIENT CONCERNS: We present the case of a calcifying tumorous lesion found incidentally in the mesentery of the terminal ileum of a 34-year-old male patient in February 2016 undergoing a computed tomography for a urinary tract infection. DIAGNOSIS: Histopathological and immunhistochemical examination after surgery revealed a CFT. INTERVENTIONS: Our patient underwent lower abdominal median laparotomy for tumorectomy. OUTCOMES: Two years after surgery the patient is free of a recurrence. LESSIONS: We add another case of intra-abdominal CFT to medical literature to provide more information about this very seldom tumor. While the etiology of CFT should be further investigated, diagnosis and therapy seem clarified. CFT should be kept in mind as a rare differential diagnosis of calcifying tumors also in the abdominal cavity. Immunohistological work-up is important for finding the diagnosis and may also help solving pathogenetical questions.


Assuntos
Calcinose/diagnóstico , Calcinose/cirurgia , Neoplasias do Íleo/diagnóstico , Neoplasias do Íleo/cirurgia , Neoplasias de Tecido Fibroso/diagnóstico , Neoplasias de Tecido Fibroso/cirurgia , Adulto , Calcinose/patologia , Diagnóstico Diferencial , Humanos , Neoplasias do Íleo/patologia , Achados Incidentais , Masculino , Mesentério/diagnóstico por imagem , Mesentério/patologia , Mesentério/cirurgia , Neoplasias de Tecido Fibroso/patologia
16.
G Chir ; 39(6): 383-387, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30563603

RESUMO

AIM: Complication of Crohn's disease (CD) of the small intestine is small bowel adenocarcinoma (SBA). A lot of studies on Crohn's disease have estimated the increased relative risk of small bowel carcinoma compared to the general population. In clinical settings, it is difficult to detect SBA in CD, therefore most of cases are diagnosed after surgery for strictures without suspicion of malignancy. CASE REPORT: The present case concerns a 48-year-old man with a suspicious 5-year history of untreated chronic inflammatory bowel disease. The patient was admitted to our unit with persistent abdominal pain, 20 kg weight loss and intestinal obstruction, confirmed at CT scans. It was performed an emergency laparotomy, terminal ileus was resected and intestinal continuity was restored. Histological examination revealed a poorly differentiated adenocarcinoma. DISCUSSION: The risk factors of SBA include long-standing and extensive Crohn's disease, young age, male sex, smoke, early onset, complications such as strictures and fistulas The most common clinical presentation of small bowel carcinoma in Crohn's disease is intestinal obstruction accompanied by wheight loss. The diagnosis is very difficult because imaging techniques may not be able to differentiate areas of small bowel carcinomas from benign fibrotic or acute inflammatory strictures. CONCLUSION: Small bowel adenocarcinoma is a rare disease but this evenience must be considered in patients with strictures for Crohn's disease. Preoperative diagnosis is still highly challenging despite significant radiological and endoscopic progress.


Assuntos
Adenocarcinoma/etiologia , Doença de Crohn/complicações , Neoplasias do Íleo/etiologia , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Antirreumáticos/efeitos adversos , Antirreumáticos/uso terapêutico , Doença de Crohn/tratamento farmacológico , Humanos , Neoplasias do Íleo/cirurgia , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Infliximab/efeitos adversos , Infliximab/uso terapêutico , Metástase Linfática , Masculino , Desnutrição/etiologia , Desnutrição/terapia , Pessoa de Meia-Idade , Nutrição Parenteral Total , Fumar/efeitos adversos , Tempo para o Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidores
17.
BMJ Case Rep ; 20182018 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-30381306

RESUMO

Ileal schwannomas are extremely rare tumours. Very few cases have been previously reported. Most cases present with abdominal pain and gastrointestinal bleeding; intussusception is a rare presentation. Due to limitations in imaging modalities, arriving at a diagnosis preoperatively can be challenging. The only reliable method of diagnosis, and treatment, is resection of the tumour, followed by histological and immunohistochemical testing. This report details the rare case of intussusception as the presenting feature of an ileal schwannoma.


Assuntos
Íleo/patologia , Intestino Delgado/patologia , Intussuscepção/etiologia , Neurilemoma/complicações , Dor Abdominal/diagnóstico , Adulto , Anastomose Cirúrgica , Feminino , Humanos , Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Íleo/inervação , Intestino Delgado/inervação , Intussuscepção/diagnóstico por imagem , Intussuscepção/patologia , Laparotomia/métodos , Neurilemoma/metabolismo , Neurilemoma/cirurgia , Neurilemoma/ultraestrutura , Doenças Raras , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
19.
Pol J Pathol ; 69(1): 82-86, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29895131

RESUMO

A woman underwent surgical intervention for a carcinoma of the ovary. In the intervention, a submucosal nodule of the ileum was found. Pathological study revealed a spindle cell lipoma (SCL). This case revealed the presence of CD34-positive spindle and stellate cells with dendritic cytoplasmic prolongations, a feature shared with dendritic fibromyxolipoma. Fluorescence in in situ hybridisation analysis showed 13q14 heterozygous deletion. Spindle cell lipoma of the small intestine has not been previously reported. Spindle cell lipoma, although rare, should be included among the benign mesenchymal lesions of the small intestine. This report extends the range of locations in which this tumour is found to arise.


Assuntos
Neoplasias do Íleo/patologia , Achados Incidentais , Lipoma/patologia , Idoso , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Biópsia , Deleção Cromossômica , Cromossomos Humanos Par 13 , Feminino , Humanos , Neoplasias do Íleo/química , Neoplasias do Íleo/genética , Neoplasias do Íleo/cirurgia , Imuno-Histoquímica , Hibridização in Situ Fluorescente , Lipoma/química , Lipoma/genética , Lipoma/cirurgia
20.
Endokrynol Pol ; 69(3): 313-317, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29952421

RESUMO

A case of 25- years-old female with NET deriving from Meckel's diverticulum is described. The patient had one year history of dermatological skin problems. Ultrasound examination of abdomen performed because of arterial hypertension, revealed multiple hepatic lesions, which was confirmed in contrast enhanced CT. The typical contrast enhanced metastatic lesions in CT and elevated levels of chromogranin A suggested NET of unknown origin. SRS with 99mTc-HYNICTOC was perform for primary tumor localization, and revealed liver and paraaortic lymph nodes metastases, but no sign of primary tumor location. As a next step for primary tumor localization 68Ga-DOTATATE PET/CT was done, which revealed focus of increased uptake in small intestine considered to be the primary tumor site. The imaging and clinical history of patient was discussed on ENETS Tumor Board. Due to location of primary tumor in the small intestine with no anatomical changes in CT, laparotomy guided with gamma probe after 68Ga-DOTATATE injection was performed. During surgery procedure, the primary tumor was hardly palpable in the tip of Meckel's diverticulum, confirmed by gamma probe. After surgery, tandem peptide receptor radionuclide therapy (PRRT) was started. Patient received 4 doses of 90Y/177Lu-DOTATATE with total activity of 360 mCi (13.32 GBq). The three months follow up 68Ga-DOTATATE PET/CT had shown stable disease of patient. The presented case showed importance role of multidisciplinary team cooperation in patient management. Use of RGS is essential in cases like presented, when the tumor cannot be localized only by surgical palpation.


Assuntos
Neoplasias do Íleo/diagnóstico por imagem , Divertículo Ileal/diagnóstico por imagem , Tumores Neuroendócrinos/diagnóstico por imagem , Octreotida/análogos & derivados , Compostos Organometálicos/uso terapêutico , Adulto , Gerenciamento Clínico , Feminino , Humanos , Neoplasias do Íleo/diagnóstico , Neoplasias do Íleo/tratamento farmacológico , Neoplasias do Íleo/cirurgia , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/tratamento farmacológico , Tumores Neuroendócrinos/cirurgia , Octreotida/uso terapêutico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/uso terapêutico , Telemedicina
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