Cistoadenocarcinoma biliar / Biliary Cystadenocarcinoma

Introducción: El cistoadenocarcinoma biliar es un tumor quístico poco frecuente, que se origina a partir del epitelio hepatobiliar, cuyo crecimiento es lento y sus síntomas son variables e inespecíficos. Objetivo: Presentar el caso de un paciente portador de un cistoadenocarcinoma biliar. Presentación del caso: Se presenta el caso de una paciente femenina de 56 años de edad que acude a la institución por presentar dolor en el hipocondrio derecho, fiebre y pérdida de peso. Al examen físico se constata una masa palpable en dicha zona abdominal, de bordes lisos, no dolorosa, dura, de escasa movilidad y relacionada con el hígado. Conclusiones: El cistoadenocarcinoma biliar es una neoplasia quística maligna poco frecuente del hígado. La mayoría de los pacientes presentan dolor abdominal, masa palpable y pérdida de peso. El tratamiento quirúrgico es la norma y la resección con márgenes libres se considera la variante de tratamiento más empleada(AU)

Introduction: Biliary cystadenocarcinoma is a rare cystic tumor, which originates from the hepatobiliary epithelium, whose growth is slow, and whose symptoms are variable and nonspecific. Objective: To present the case of a patient with a biliary cystadenocarcinoma. Case presentation: The case is presented of a 56-year-old female patient who came to our institution with pain in the right hypochondrium, fever and weight loss. Physical examination revealed a palpable mass in such abdominal area, with smooth edges, nonpainful, hard, with low mobility and related to the liver. Conclusions: Biliary cystadenocarcinoma is a rare malignant cystic neoplasm of the liver. Most patients present with abdominal pain, a palpable mass and weight loss. Surgery is the standard treatment and margin-free resection is considered the most commonly employed treatment variant(AU)

Clinical-epidemiological, anatomic-pathological, histochemical and immunohistochemical characterization of renal cystadenocarcinoma-nodular dermatofibrosis syndrome in 11 German Shepherd dogs / Caracterização clínico-epidemiológica, anátomo-patológica, histoquímica e imuno-histoquímica da síndrome cistadenocarcinoma-dermatofibrose nodular em 11 cães Pastor Alemão

Eleven cases of renal cystadenoma/cystadenocarcinoma-nodular dermatofibrosis syndrome (RCND) are described in German Shepherd dogs diagnosed from January 1994 to January 2018 at the Veterinary Pathology Laboratory of the "Universidade Federal de Santa Maria" (LPV-UFSM). The study sample was composed of eight male and three female dogs at a ratio of 2.67:1. Age ranged from six to 12 years (mean=8.7 years). The main clinical signs reported in descending order of frequency were multiple cutaneous nodules (nodular dermatofibrosis), dyspnea, anorexia, weight loss, recurrent hematuria, vomiting, and polydipsia. Results demonstrated that it is not always easy to clinically recognize this syndrome, but its peculiar anatomical-pathological characteristics allow safe diagnosis. Histologically, it was possible to detect all phases (cysts, papillary intratubular hyperplasia, and cystadenomas or cystadenocarcinomas) of a possible pathological continuum of the renal lesions. Uterine leiomyomas were observed in only one of the cases. Through histochemical techniques, it was possible to identify the presence of type I collagen in both cutaneous and renal lesions and consider its possible involvement in the pathogenesis of renal cystadenocarcinoma. Immunohistochemistry (IHC) showed partially satisfactory results in the staining of epithelial cells of renal cysts and neoplasms for pan-cytokeratin.(AU)

São descritos 11 casos da síndrome cistadenoma/cistadenocarcinoma-dermatofibrose nodular (CR-DN) em cães Pastor Alemão, diagnosticados entre janeiro de 1994 e janeiro de 2018 no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria (LPV-UFSM). Os cães afetados foram oito machos e três fêmeas, estabelecendo-se uma relação de 2,67:1. A idade variou de seis a 12 anos, sendo a média de idade de 8,7 anos. Os principais sinais clínicos relatados foram, em ordem decrescente de frequência, múltiplos nódulos cutâneos (dermatofibrose nodular), dispneia, anorexia, emagrecimento, hematúria recorrente, vômito e polidipsia. Este estudo permitiu estabelecer que o reconhecimento clínico da síndrome nem sempre é fácil, porém suas características anátomo-patológicas peculiares permitem um diagnóstico com segurança. Histologicamente, foi possível detectar todas as fases (cistos, hiperplasia intratubular papilífera, cistadenomas ou cistadenocarcinomas) de um possível continuum patológico das lesões renais. Leiomiomas uterinos foram observados somente em um caso. Através das técnicas histoquímicas foi possível estabelecer que o colágeno tipo I está presente em ambas as lesões, cutâneas e renais, e cogitar seu possível envolvimento na patogênese dos cistadenocarcinomas renais. A técnica de IHQ mostrou resultados parcialmente satisfatórios na imunomarcação das células epiteliais dos cistos e dos neoplasmas renais para pancitoceratina.(AU)

Clinical-epidemiological, anatomic-pathological, histochemical and immunohistochemical characterization of renal cystadenocarcinoma-nodular dermatofibrosis syndrome in 11 German Shepherd dogs / Caracterização clínico-epidemiológica, anátomo-patológica, histoquímica e imuno-histoquímica da síndrome cistadenocarcinoma-dermatofibrose nodular em 11 cães Pastor Alemão

Eleven cases of renal cystadenoma/cystadenocarcinoma-nodular dermatofibrosis syndrome (RCND) are described in German Shepherd dogs diagnosed from January 1994 to January 2018 at the Veterinary Pathology Laboratory of the "Universidade Federal de Santa Maria" (LPV-UFSM). The study sample was composed of eight male and three female dogs at a ratio of 2.67:1. Age ranged from six to 12 years (mean=8.7 years). The main clinical signs reported in descending order of frequency were multiple cutaneous nodules (nodular dermatofibrosis), dyspnea, anorexia, weight loss, recurrent hematuria, vomiting, and polydipsia. Results demonstrated that it is not always easy to clinically recognize this syndrome, but its peculiar anatomical-pathological characteristics allow safe diagnosis. Histologically, it was possible to detect all phases (cysts, papillary intratubular hyperplasia, and cystadenomas or cystadenocarcinomas) of a possible pathological continuum of the renal lesions. Uterine leiomyomas were observed in only one of the cases. Through histochemical techniques, it was possible to identify the presence of type I collagen in both cutaneous and renal lesions and consider its possible involvement in the pathogenesis of renal cystadenocarcinoma. Immunohistochemistry (IHC) showed partially satisfactory results in the staining of epithelial cells of renal cysts and neoplasms for pan-cytokeratin.(AU)

São descritos 11 casos da síndrome cistadenoma/cistadenocarcinoma-dermatofibrose nodular (CR-DN) em cães Pastor Alemão, diagnosticados entre janeiro de 1994 e janeiro de 2018 no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria (LPV-UFSM). Os cães afetados foram oito machos e três fêmeas, estabelecendo-se uma relação de 2,67:1. A idade variou de seis a 12 anos, sendo a média de idade de 8,7 anos. Os principais sinais clínicos relatados foram, em ordem decrescente de frequência, múltiplos nódulos cutâneos (dermatofibrose nodular), dispneia, anorexia, emagrecimento, hematúria recorrente, vômito e polidipsia. Este estudo permitiu estabelecer que o reconhecimento clínico da síndrome nem sempre é fácil, porém suas características anátomo-patológicas peculiares permitem um diagnóstico com segurança. Histologicamente, foi possível detectar todas as fases (cistos, hiperplasia intratubular papilífera, cistadenomas ou cistadenocarcinomas) de um possível continuum patológico das lesões renais. Leiomiomas uterinos foram observados somente em um caso. Através das técnicas histoquímicas foi possível estabelecer que o colágeno tipo I está presente em ambas as lesões, cutâneas e renais, e cogitar seu possível envolvimento na patogênese dos cistadenocarcinomas renais. A técnica de IHQ mostrou resultados parcialmente satisfatórios na imunomarcação das células epiteliais dos cistos e dos neoplasmas renais para pancitoceratina.(AU)

Rare biliary cystic tumors: a case series of biliary cystadenomas and cystadenocarcinoma.

Cystic lesions of the liver are common and a major proportion is formed by parasitic cysts and simple cysts. Biliary cystic tumors (BCTs), namely biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC), are rare tumors which usually arise from the intrahepatic biliary tree. BCAs have malignant potential and are difficult to differentiate from BCAC pre-operatively on radiological imaging. Here we have presented 4 patients with BCTs and reviewed the literature pertaining to them.The data of four patients with BCA/BCAC diagnosed and treated at our institute were retrieved from our database and records were reviewed for age, sex, history, imaging, surgery, pathology and follow-up. Mean age of the patients was 53.5 years (range 30-71 years). Two male and two female patients presented with abdominal pain, of which one male patient had pancreatitis at diagnosis. Characteristic features were seen on pre-operative imaging (cystic lesions with internal septations) and biliary communication was identified in the patient with pancreatitis. Three patients were diagnosed with a BCA on final histology, while one patient had a BCAC. Following surgical resection, all the patients are asymptomatic and disease free with a mean follow-up of 24 months (range 10-40 months). In conclusion, BCTs should be suspected in the presence of a well-encapsulated, cystic hepatic lesion with internal septations. Although pre-operative distinction between BCA and BCAC is difficult, the lesion, whenever possible, should be completely resected as long-term outcomes are good, especially with BCA.

Dermatofibrose nodular em cão - caso clínico / Nodular dermatofibrosis in a dog - case report / Dermatofibrosis nodular en perro - caso clínico

A dermatofibrose nodular é uma síndrome em que o aparecimento de nódulos dérmicos fibróticos é associado a uma doença cística renal concomitante e progressiva, que se apresenta em cães de meia-idade a idosos da raça pastor alemão. Supõe-se que para essa síndrome haja base genética. Os principais sinais clínicos são dermatológicos, e incluem pápulas e nódulos nos membros (carpo, tarso, metacarpo e metatarso), dígitos, região cefálica, perilabial e, mais raramente, tronco. Os nódulos são firmes e hiperpigmentados, podendo ser cutâneos ou subcutâneos. Sinais sistêmicos também são observados e relacionados. Há insuficiência renal secundária devido à presença de cistos renais unilaterais ou bilaterais, cistadenoma ou cistadenocarcinoma renal, além de leiomiomas uterinos concomitantes. O diagnóstico é obtido por histopatológico das lesões cutâneas e massa renal. Não existe tratamento efetivo para essa síndrome. O objetivo deste trabalho é relatar um caso de dermatofibrose nodular em um cão macho da raça pastor alemão.

Nodular dermatofibrosis is a syndrome that affects middle-aged to old German shepherds, in which the appearance of dermal fibrotic nodules is associated with a concomitant and progressive kidney cystic disease. The cause is putatively genetic and the main clinical signs are of dermatological character, including papules and nodules on the limbs (carpus, tarsus, metacarpus and metatarsus), digits, cephalic region, and the trunk, albeit less frequently. The nodules are firm and hyperpigmented and can be cutaneous or subcutaneous. Systemic signs are also observed and related. There can be kidney insufficiency secondary to unilateral or bilateral kidney epithelial cysts, kidney cystadenoma or cystadenocarcinoma, as well as concomitant uterine leiomyomas. Diagnosis is obtained by histopathology of skin lesions and of the kidney mass. There is no effective treatment for this syndrome. The aim of this study is to report a case of nodular dermatofibrosis in a male German shepherd.

La dermatofibrosis nodular es un síndrome en el cual se asocian la presencia de nódulos dérmicos fibróticos a una enfermedad renal cística y progresiva, que suele presentarse en perros Ovejeros alemanes de edad media a viejos. Se cree que existe una base genética para este síndrome. Los principales signos clínicos son dermatológicos, como pápulas y nódulos en los miembros (carpo, tarso, metacarpo y metatarso), dígitos, región cefálica, región perilabial y, raramente, en tronco. Los nódulos son firmes e hiperpigmentados, y pueden ser cutáneos o subcutáneos. También pueden observarse alteraciones sistémicas relacionadas con esta enfermedad. La insuficiencia renal es secundaria a la presencia de quistes renales (uni o bilaterales), y neoplasias como adenomas y adenocarcinomas de riñón, además de leiomiomas uterinos. El diagnóstico se consigue a través de la histopatología de las lesiones cutáneas y de la masa renal. No existe un tratamiento efectivo contra este síndrome. El objetivo de este trabajo es relatar un caso de dermatofibrosis nodular en um perro Ovejero alemán.

Dermatofibrose nodular em cão - caso clínico / Nodular dermatofibrosis in a dog - case report / Dermatofibrosis nodular en perro - caso clínico

A dermatofibrose nodular é uma síndrome em que o aparecimento de nódulos dérmicos fibróticos é associado a uma doença cística renal concomitante e progressiva, que se apresenta em cães de meia-idade a idosos da raça pastor alemão. Supõe-se que para essa síndrome haja base genética. Os principais sinais clínicos são dermatológicos, e incluem pápulas e nódulos nos membros (carpo, tarso, metacarpo e metatarso), dígitos, região cefálica, perilabial e, mais raramente, tronco. Os nódulos são firmes e hiperpigmentados, podendo ser cutâneos ou subcutâneos. Sinais sistêmicos também são observados e relacionados. Há insuficiência renal secundária devido à presença de cistos renais unilaterais ou bilaterais, cistadenoma ou cistadenocarcinoma renal, além de leiomiomas uterinos concomitantes. O diagnóstico é obtido por histopatológico das lesões cutâneas e massa renal. Não existe tratamento efetivo para essa síndrome. O objetivo deste trabalho é relatar um caso de dermatofibrose nodular em um cão macho da raça pastor alemão.(AU)

Nodular dermatofibrosis is a syndrome that affects middle-aged to old German shepherds, in which the appearance of dermal fibrotic nodules is associated with a concomitant and progressive kidney cystic disease. The cause is putatively genetic and the main clinical signs are of dermatological character, including papules and nodules on the limbs (carpus, tarsus, metacarpus and metatarsus), digits, cephalic region, and the trunk, albeit less frequently. The nodules are firm and hyperpigmented and can be cutaneous or subcutaneous. Systemic signs are also observed and related. There can be kidney insufficiency secondary to unilateral or bilateral kidney epithelial cysts, kidney cystadenoma or cystadenocarcinoma, as well as concomitant uterine leiomyomas. Diagnosis is obtained by histopathology of skin lesions and of the kidney mass. There is no effective treatment for this syndrome. The aim of this study is to report a case of nodular dermatofibrosis in a male German shepherd.(AU)

La dermatofibrosis nodular es un síndrome en el cual se asocian la presencia de nódulos dérmicos fibróticos a una enfermedad renal cística y progresiva, que suele presentarse en perros Ovejeros alemanes de edad media a viejos. Se cree que existe una base genética para este síndrome. Los principales signos clínicos son dermatológicos, como pápulas y nódulos en los miembros (carpo, tarso, metacarpo y metatarso), dígitos, región cefálica, región perilabial y, raramente, en tronco. Los nódulos son firmes e hiperpigmentados, y pueden ser cutáneos o subcutáneos. También pueden observarse alteraciones sistémicas relacionadas con esta enfermedad. La insuficiencia renal es secundaria a la presencia de quistes renales (uni o bilaterales), y neoplasias como adenomas y adenocarcinomas de riñón, además de leiomiomas uterinos. El diagnóstico se consigue a través de la histopatología de las lesiones cutáneas y de la masa renal. No existe un tratamiento efectivo contra este síndrome. El objetivo de este trabajo es relatar un caso de dermatofibrosis nodular en um perro Ovejero alemán.(AU)

Tumores hepáticos malignos no hepatocelulares. 2.a parte. Aspectos morfológicos y estudios auxiliares de importancia útiles para el diagnóstico histopatológico / Malignant Hepatic Neoplasms. Part 2. Morphology and important ancillary studies useful for histopathological diagnosis

Se continúa con la revisión de los tumores malignos hepáticos primarios. Se hablará de los aspectos más importantes de los tumores primarios no hepatocelulares, siendo más frecuentes los originados en el epitelio del ducto biliar como el colangiocarcinoma, el cistoadenocarcinoma y los tumores mesenquimales, y los más infrecuentes el hemangioendotelioma epitelioide y el angiosarcoma. La principal dificultad radica en lograr el diagnóstico definitivo, el cual se basa en la exclusión de una neoplasia primaria extrahepática o de lesiones hepáticas benignas. Estudios adicionales de inmunohistoquímica, estudios de clonalidad o moleculares pueden ser de mucha utilidad.

We continue with the review of primary malignant liver tumors. This article covers the most important aspects of primary tumors that are not hepatocellular. Those that originate in the epithelium of the bile duct such as cholangiocarcinoma, cystadenocarcinoma and mesenchymal tumors occur most frequently. Epithelioid hemangioendothelioma and angiosarcoma occur less frequently. The main difficulty lies in making a definitive diagnosis which must be based on the exclusion of extrahepatic primary neoplasms and benign liver lesions. Additional immunohistochemistry and molecular studies as well as diagnostic cloning of cells can be very useful.

The risk of carcinogenesis in congenital choledochal cyst patients: an analysis of 214 cases.

BACKGROUND: Choledochal cysts are most common in Asian populations. In addition, the incidence of biliary tract malignancies from choledochal cysts is increasing, but the risk of carcinogenesis is still unclear. MATERIAL AND METHODS: Clinical data from 214 congenital choledochal cyst cases from 1968 to 2013 were retrospectively analyzed. RESULTS: Todani type I was more common (139, 65.0%) than type IVa (53, 24.8%) or type V (17, 7.9%) in these choledochal cyst patients. Biliary tract malignant tumors occurred in the gallbladder (2, 13.3%), common bile duct (10, 66.7%), and intrahepatic bile duct (3, 20%) in 15 patients (7.0%), including one patient in whom malignant transformation occurred in the intrahepatic bile duct in a type IVa patient 15 years after extrahepatic cyst resection. An age at symptom onset ≥ 60 years was a risk factor (p < 0.001), while an initial complete surgery was a protective factor for carcinogenesis (p = 0.001). CONCLUSIONS: Choledochal cysts should be removed once diagnosed because of an increased risk of malignant transformation with increasing age. Complete cyst removal is necessary for the first surgical treatment. Additional hepatectomy should be considered for type IVa choledochal cysts because cholangiocarcinoma can arise from the intrahepatic bile duct years after the extrahepatic cyst excision.

Surgical management of biliary cystadenoma and cystadenocarcinoma of the liver.

Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are rare biliary duct neoplasms. This study investigated reasonable management strategies of cystic neoplasms in the liver. Charts of 39 BCA/BCAC patients (9 males, 30 female; median age 53.74 ± 14.50 years) who underwent surgery from January 1999 to December 2009 were reviewed retrospectively. Cyst fluid samples of 32 BCA/BCAC patients and 40 simple hepatic cyst patients were examined for the tumor markers carbohydrate associated antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA). The most frequent symptoms were abdominal pain (N = 10), abdominal mass (N = 7), abdominal distension (N = 4), jaundice (N = 2), and fever (N = 3); the remaining patients showed no clinical symptoms. Liver resection (N = 17) or enucleation (N = 22) was performed in the 39 patients. Ultimately, 35 patients were diagnosed with intrahepatic BCA and four patients were diagnosed with BCAC. The median CA19-9 level was significantly higher in BCA/BCAC patients than in simple hepatic cyst patients. The median CEA levels in BCA/BCAC patients and controls were 6.83 ± 2.43 and 4.21 ± 2.91 mg/L, respectively. All symptoms were resolved after surgery, and only one BCAC patient showed recurrence. The incidence of intrahepatic cystic lesions was 1.7%. Increased CA19-9 levels in the cyst fluid is a helpful marker for distinguishing BCA/BCAC from common simple cysts. The presence of coarse calcifications is suggestive of BCAC. Complete surgical removal of these lesions yielded satisfying long-term outcomes with a very low recurrence rate.

TTD consensus document on the diagnosis and management of exocrine pancreatic cancer.

Exocrine pancreatic cancer (PC) is a very aggressive and heterogeneous tumor with several cellular signaling pathways implicated in its pathogenesis and maintenance. Several risk factors increase the risk of developing PC. Therapeutic strategies used are dictated by the extent of disease. Supportive treatment is critical because of the high frequency of symptoms. For localized disease, surgery followed by adjuvant gemcitabine is the standard. Neoadjuvant and new adjuvant chemotherapy regimens are being evaluated. Locally advanced disease should respond best guided by a multidisciplinary team. Various treatment options are appropriate such as chemotherapy alone or chemoradiotherapy with integration of rescue surgery if the tumor becomes resectable. In metastatic disease, chemotherapy should be reserved for patients with ECOG 0-1 using Folfirinox or gemcitabine plus nab-paclitaxel as the most recommended options. Several therapeutic strategies targeting unregulated pathways are under evaluation with an unmet need for biomarkers to guide management.

Incorporating inter-relationships between different levels of genomic data into cancer clinical outcome prediction.

In order to improve our understanding of cancer and develop multi-layered theoretical models for the underlying mechanism, it is essential to have enhanced understanding of the interactions between multiple levels of genomic data that contribute to tumor formation and progression. Although there exist recent approaches such as a graph-based framework that integrates multi-omics data including copy number alteration, methylation, gene expression, and miRNA data for cancer clinical outcome prediction, most of previous methods treat each genomic data as independent and the possible interplay between them is not explicitly incorporated to the model. However, cancer is dysregulated by multiple levels in the biological system through genomic, epigenomic, transcriptomic, and proteomic level. Thus, genomic features are likely to interact with other genomic features in the different genomic levels. In order to deepen our knowledge, it would be desirable to incorporate such inter-relationship information when integrating multi-omics data for cancer clinical outcome prediction. In this study, we propose a new graph-based framework that integrates not only multi-omics data but inter-relationship between them for better elucidating cancer clinical outcomes. In order to highlight the validity of the proposed framework, serous cystadenocarcinoma data from TCGA was adopted as a pilot task. The proposed model incorporating inter-relationship between different genomic features showed significantly improved performance compared to the model that does not consider inter-relationship when integrating multi-omics data. For the pair between miRNA and gene expression data, the model integrating miRNA, for example, gene expression, and inter-relationship between them with an AUC of 0.8476 (REI) outperformed the model combining miRNA and gene expression data with an AUC of 0.8404. Similar results were also obtained for other pairs between different levels of genomic data. Integration of different levels of data and inter-relationship between them can aid in extracting new biological knowledge by drawing an integrative conclusion from many pieces of information collected from diverse types of genomic data, eventually leading to more effective screening strategies and alternative therapies that may improve outcomes.

Cystadenocarcinoma arising from ovary in a three year old doberman bitch / Cistoadenocarcinoma derivado del ovario en una perra doberman de tres años

A three- year- old Doberman was presented with complaint of lethargy and weight- loss. Physical examination revealed a mass in the right abdomen. Laboratory abnormalities included anaemia, azotaemia and metabolic acidosis. Sonogram of the mass was an anaechoic area surrounded by hypoechoic tissue. The mass was located between the right kidney and ovary and showed papillary and tubular pattern of cystadenocarcinoma. Nephroureterectomy and ovariohysterectomy was performed; however bitch was euthanized owing to poor improvement, while necropsy of the left kidney revealed an end-stage kidney. It was concluded that the cystadenocarcinoma must have arisen secondary to a primary ovarian adenocarcinoma through stromal invasion.

Se presentó una perra doberman de tres años de edad aquejada de letargo y pérdida de peso. El examen físico reveló una masa en el abdomen derecho. El examen de laboratorio mostró anormalidades que incluyeron anemia, azotemia y acidosis metabólica. La ecografía de la masa mostró un área anecoica rodeada por tejido hipoecoico. La masa se localizó entre el riñón derecho y ovario y mostró el patrón papilar y tubular del cistoadenocarcinoma. Se realizó la nefroureterectomía y ovariohisterectomía, sin embargo la perra fue sacrificada debido a la falta de mejoría, donde la autopsia del riñón izquierdo reveló un riñón en etapa terminal. Se concluyó que el cistoadenocarcinoma debió haber surgido secundario a un adenocarcinoma primario de ovario a través de la invasión del estroma.

Cistoadenocarcinoma simulando hemangiossarcoma de glândula salivar em cão: relato de caso / Cystadenocarcinoma simulating hemangiosarcoma of the salivary gland in dog: case report

Cystadenocarcinoma is regarded as a rare adenocarcinoma variant in animals. This work reports the case of an 8-year-old female Poodle dog with salivary gland cystadenocarcinoma with morphological characteristics similar to a hemangiosarcoma. Histopathological analysis showed a tumor mass with cystic formations containing a large amount of red blood cells. In order to distinguish these two entities, periodic acid Schiff (PAS) staining and immunohistochemical analysis were carried out with the use of cytokeratin AE1/AE3 (CK) and CD31-specific antibodies. Neoplastic cells were PAS-negative, CK-positive and CD31-negative confirming their epithelial origin. Based on the findings, the diagnosis of high grade cystadenocarcinoma was established.

O cistoadenocarcinoma é considerado uma variante do adenocarcinoma de rara ocorrência em animais. Este trabalho relata um caso de cadela Poodle de oito anos, portadora de cistoadenocarcinoma de glândula salivar com características morfológicas semelhantes a de hemangiossarcoma. Na análise histopatológica observou-se uma massa tumoral com formações císticas contendo grande quantidade de hemácias. Para a diferenciação entre as duas entidades realizou-se coloração pelo ácido periódico de Schiff (PAS) e análise imuno-histoquímica com a utilização de anticorpos para citoqueratina AE1/AE3 (CK) e CD31. As células neoplásicas apresentaram-se PAS negativas, CK positivas e CD31 negativas demonstrando a origem epitelial. Com base nos achados firmou-se o diagnóstico de cistoadenocarcinoma de alto grau.

Tumor borderline de ovário bilateral: relato de caso em paciente de 29 anos de idade / Borderline tumors of both ovaries: case report in a patient 29 years of age

O tumor borderline de ovário representa de 10 a 15% das neoplasias ovarianas. Frequentemente acomete mulheres na fase reprodutiva, sendo mais comum por volta dos 40 anos de idade. A bilateralidade ocorre em cerca de 5% dos casos. Histologicamente apresenta características intermediárias entre tumores claramente benignos e carcinomas francamente invasivos, o que dificultao seu diagnóstico. O estadiamento cirúrgico segue os mesmos princípios aplicados para os casos de câncer ovariano invasor, porém os tumores borderline apresentam melhor prognóstico que os carcinomas, o que torna controversa a necessidade do estadiamento cirúrgico completo ou terapias adjuvantes. Este trabalho tem como objetivo relatar o caso de uma paciente de 29 anos de idade, assintomática, com estudo ultrassonográfico de rotina evidenciando um cisto complexo anexial esquerdo. A paciente foi submetida ao estadiamento cirúrgico e diagnosticada inicialmente como portadora de cistadenocarcinoma papilar seroso de ovário bilateral, sendo submetida à quimioterapia. Após revisão de exame anátomo-patológico evidenciou-se o diagnóstico de tumor borderline de ovário bilateral

Tumor borderline de ovário bilateral: relato de caso em paciente de 29 anos de idade

O tumor borderline de ovário representa de 10 a 15% das neoplasias ovarianas. Frequentemente acomete mulheres na fase reprodutiva, sendo mais comum por volta dos 40 anos de idade. A bilateralidade ocorre em cerca de 5% dos casos. Histologicamente apresenta características intermediárias entre tumores claramente benignos e carcinomas francamente invasivos, o que dificultao seu diagnóstico. O estadiamento cirúrgico segue os mesmos princípios aplicados para os casos de câncer ovariano invasor, porém os tumores borderline apresentam melhor prognóstico que os carcinomas, o que torna controversa a necessidade do estadiamento cirúrgico completo ou terapias adjuvantes. Este trabalho tem como objetivo relatar o caso de uma paciente de 29 anos de idade, assintomática, com estudo ultrassonográfico de rotina evidenciando um cisto complexo anexial esquerdo. A paciente foi submetida ao estadiamento cirúrgico e diagnosticada inicialmente como portadora de cistadenocarcinoma papilar seroso de ovário bilateral, sendo submetida à quimioterapia. Após revisão de exame anátomo-patológico evidenciou-se o diagnóstico de tumor borderline de ovário bilateral

Cistoadenocarcinoma Papilar Seroso de Ovario en paciente de 16 Años, Reporte de un Caso / Serous papillary ovarian cystadenocarcinoma in an 16-year-old patient, a case report

Se presenta el caso clínico de una paciente de 16 años, nulípara, que acude al Hospital Materno Infantil Germán Urquidi de Cochabamba con cuadro clínico de ocho meses de evolución presentando distensión abdominal, sensación de opresión y dolor en hipogastrio, estreñimiento y pérdida de 8 kg de peso durante dicho periodo, sin ningún antecedente patológico de relevancia. Al examen físico se palpa masa en hemiabdomen inferior de 20 por 16 cm, irregular y sólida, adherida a estructuras pélvicas, (determinado mediante tacto rectal) por lo que se hospitaliza con diagnóstico de cáncer de ovario; realizándose laboratorios, marcadores tumorales, estudios de gabinete y laparotomía diagnóstica, etapificadora y citoreductora. El reporte histopatológico indica cistoadenocarcinoma papilar seroso de ovario, cuya etapificación quirúrgica corresponde al estadio IIIc. La paciente cursa en forma favorable su post quirúrgico para posteriormente continuar su tratamiento con quimioterapia por consulta externa del servicio de oncología en el Hospital clínico Viedma. Se revisarán aspectos relacionados a su frecuencia, etiología, diagnóstico y manejo médico quirúgico de esta patología.

A case report of a 16-year-old patient, nulliparous, admitted to the Hospital Maternológico Infantil Germán Urquidi, with a eight-month history of abdominal distention, tightness and pain in lower abdomen, constipation and loss of 8 kg weight during this period, with no history of pathological significance.To the physical examination, it was found a palpable lower abdominal mass of 20 by 16 cm, irregular, solid, stucked to pelvic structures(determined by DRE).The patient was hospitalized with the diagnosis of ovarian cancer; performing laboratories, tumor markers, cabinet studies, diagnostic laparotomy cytoreductive stage defining. The pathological report indicated ovarian serous cystadenocarcinoma, whose surgical staging is a IIIC stage. The patient's evolution has been favorable after the surgical treatment, it may continue eith outpatient chemotherapy in the department of oncology at the Hospital Viedma. Aspects related to frecuency, etiology, diagnosis and médical management of this condition will be reviewed.

Biliary cystadenocarcinoma with mesenchymal stroma.

Hepatobiliary cystadenocarcinomas (BCACs) with mesenchymal stroma are a rare cystic lesion. This tumour needs to be distinguished from benign biliary cystadenoma, which is antecedent in most cases. The treatment of choice is radical excision of the mass. The diagnostic evaluation, surgical management, pathological characteristics, treatment and follow-up of one patient with hepatobiliary cystadenocarcinoma with ovarian stroma is described. Preoperative diagnosis of BCACs is often difficult, because their clinical manifestations are similar to those of other hepatic cystic lesions. MRI is suitable for accurate characterisation of cystic biliary lesions, but distinguishing between cystadenoma and cystadenocarcinoma remains difficult on the basis of imaging findings. Complete surgical excision gives a relatively good chance of long-term survival because of the slow growth rate of these tumours.

Chylous ascites in gynecologic malignancies: cases report and literature review.

PURPOSE: Chylous ascites is an infrequent postoperative complication after retroperitoneal surgical procedure. Despite its infrequent occurrence, postoperative chylous ascites are associated with significant morbidity. Reports of chylous ascites or fistula after retroperitoneal lymph node dissection for gynecologic malignancies without radiation therapy are rare. A search in the English literature showed only 31 cases of chylous fistula for gynecologic malignancies. Treatment may be conservative with low-fat oral diet with medium-chain triglycerides associated or not to octreotide and total parenteral nutrition. In case of conservative measures failure, it can be managed by surgical intervention or peritoneo-venous shunt. METHODS: We report two cases of chylous fistula following systematic pelvic and retroperitoneal lymph node dissection for gynecological cancer without radiotherapy and review the literature. RESULTS: Both were successfully managed with the maintenance of the postoperative drain, total parenteral nutrition, octreotide and dietary intervention. CONCLUSIONS: Chylous ascites should be included in differential diagnosis of abdominal distention after surgical retroperitoneal approach or radiotherapy. Most of the patients may have their chylous ascites successfully treated with conservative management. However, the best policy is to prevent chylous complications by employing meticulous dissection techniques and careful control of the major lymphatics by suture ligation during the primary surgical intervention.