[Metastasis of carcinoma of stomach cancer simulating primary ovarian tumor. Importance of frozen biopsies]. / Metástasis de carcinoma de estómago que simula cancer primario de ovario. Importancia de la biopsia por congelación.

OBJECTIVE: The importance of frozen section in the Diagnosis and management of patients with ovarian tumors. RESULTS: We report 9 cases of patients with ovary tumors. The primary carcinoma was found during an operation for the ovarian tumor. In these cases the diagnosis of krukenberg tumor was made intraoperatively by frozen section evaluation and the primary carcinoma were found in the stomach. CONCLUSIONS: The results of the study of 9 patients with metastasis from gastric carcinoma simulating primary carcinoma of the ovary show us the importance of frozen section and the communication with the surgeon intraoperatively.

[Survival factors in 152 patients with gastrointestinal stromal tumors]. / Factores de sobrevida en 152 pacientes con tumores estromales gastrointestinales.

INTRODUCTION: The gastrointestinal stromal tumor (GIST) is the designation for a specific type of mesenchymal tumor of the digestive tract that is origin in the interstitial cells of Cajal (ICC) or its precursor multipotentials, its presentation is rare and therefore its best knowledge must affect a proper diagnosis and treatment. OBJECTIVES: To evaluate the clinical characteristics and to identify factors influencing survival of patients with gastrointestinal stromal tumor. MATERIAL AND METHODS: This study design is quantitative, non experimental, descriptive, retrospective and transversal. The study has been performed in 152 patients with gastrointestinal stromal tumor who were treated at the National Institute of Neoplastic Diseases (INEN), Lima, Peru, from January 1999 through December 2009. For the final diagnosis was registered the outcome of the surgical and histology was complemented by immunohistochemical test. To assess the normal distribution of the population was used the Shapiro-Wolk, Anderson-Darling, Lilliefors, regarding the use of inferential statistical tables for survival and to assess its significance in the univariate analysis (p <0.05 significance), was used the Wilcoxon test, Tarone-Ware Log-rank and also to evaluate the difference between groups in contingency tables used the chi square and Fisher's test. Multivariate analysis was performed using the proportional hazards model of Cox. RESULTS: The group of 152 patients included 78 women (51%) and 74 men (49%) with age range from 16 to 92 years, with an average age of 54. The frequency presentation was increased from the fourth decade of life and reaches its highest expression between 50 and 70. The initial presentation was with localized disease to 79 patients (52%) and primary metastases in 73 patients (48%), with an average time of disease 14 months. The prevalence of GIST tumor in the different organs was as follows: stomach with 77 patients (50.65%), jejunum with 21 patients (13.82%), retroperitoneum with 17 patients (11.18%), duodenum 11 patients (7.24%), colon 11 patients (7.24%), ileum 8 patients (5.26%),pancreas, 3 patients (1.97%), rectum, 3 patients (1.97%) and esophagus with 1 patient (0.66%). The most common symptoms of GIST tumors in general were gastrointestinal bleeding, abdominal tumor and abdominal pain. There are organ-specific symptoms such as jaundice in pancreas, dysphagia in esophagus and obstruction in the ileum. The tumor size greater than 10 centimeters was found in 92 patients (60.51%), 39 patients had size between 5 and 10 centimeters (25.65%) and 20 patients had lesions smaller than 5 centimeters (13.15%). Immunohistochemistry tests performed in 75 patients show that for all locations, the expression of KIT (CD117) is 94.8%, followed by CD34 to 70.35%; on the other hand, actin (61.68%) and S-100 (57.56%) have a smaller range of expression. Retroperitoneal GIST tumors had an expression of CD117 of 92.86% and CD34 of 60%, and GIST tumors of the pancreas had an expression of CD117 of 100% and CD34 of 100%. We evaluated 27 patients with low mitotic index, of which 10 had primary metastases (37%), in turn, of 25 patients with high mitotic index, 8 had primary metastases (32%). Of the 152 patients, 93 had complete resection of the disease, 28 had partial resection, 24 were unresectable and 07 did not undergo surgery, the more aggressive behavior was observed in ileum, 03 patients were unresectable, 02 patients had partial resection and only 02 could be completely resected, the rest of the series in general, for each location, the GIST tumors completely resected outscored the unresectable and partially resected. Of 93 patients that had completely resected, recurrence was found in 32 of these patients (34.4%), recurrence was local in 8 patients, metastases in 18 patients and local recurrence + metastases in 6 patients, with an average time of recurrence 22 months. The overall cumulative survival at 5 years was 81.35%. The survival of patients under and over 50 expressed a p = 0.08, cumulative survival rates by tumor size expressed p = 0.56, cumulative survival rates for stomach and intestinal location shows a p = 0.056. The 5-year survival of completely resected patients was 87.70%. Overall survival of patients with and without metastasis expressed p = 0.001, the cumulative survival function completely resected patients, the resected and partially resected, expresses with p <0.0001. Multivariate analysis showed that the most significant factor for disease progression was the primary metastases with p = 0.007, and that survival was directly related to complete resection of the disease which is expressed with p <0.0001. CONCLUSIONS: The most important prognostic factor of survival for gastrointestinal stromal tumors (GIST) is the complete resection of the disease. The factor that is associated with progression of the disease is the presence of metastases. In our series of 152 patients, tumor locations tend to relate better survival in gastric GIST that in intestinal GIST. Similarly, we found a tendency to express a lower survival in patients younger than 50 years. Differentiated tumor size in three size categories expressed no more related to survival. The low mitotic index associated with metastasis, not reflected a good prognosis of disease.

[Carcinoid tumors of the rectum: clinical - pathological correlation]. / Tumor carcinoide del recto: correlacion clinico-patologica.

OBJECTIVE: The purpose of this study was to determine the clinico-pathologic correlation of carcinoid tumors of the rectum. MATERIALS AND METHODS: We reviewed the medical records and pathology of 20 patients with carcinoid tumors of the rectum seen at the Instituto de Enfermedades Neoplásicas (INEN), between 1980 and 2006 RESULTS: There was no difference between sex. 11 patients had tumors over 2 cm. 12 had metastasis. 8 patients without metastasis had, tumors size of less than 2 cm. 6 pacients had endoscopic resection, the tumors were often polypoid, the size less than 2 cm and with typical histopathologic. 7 cases hat atypical histopathologic from them 2 patients dead, all had metastasis and tumor sizes were 3 to 6 cm. CONCLUSIONS: The tumor size, the atypical histopathologic features, the infiltration of the wall and metastasis are associated with aggressive behavior and bad prognosis.

[Krukenberg ovary tumor pathological clinical study of 56 cases in the Instituto Nacional de Enfermedades Neoplasicas (National Cancer Institute)]. / Tumor de krukenberg del ovario: estudio clinico patologico de 56 casos en el Instituto Nacional de Enfermedades Neoplasicas.

OBJECTIVE: We report 56 cases of ovary Krukenberg tumor at Instituto Nacional de Enfermedades NeoplAsicas en relation to microscopic diagnosis, primary origin and clinicopathologic correlation. RESULTS: The patients ranged from 18 to 84 years. The most frecuent primary tumor was stomach 33 (58.9%) cases. Abdominal swelling and pain usually accounted for the clinical presentation. Ascitis, abnormal vaginal bleeding. 21 patients had frozen section.11(52.3%) cases the primary carcinoma was found during an operation for the ovary tumor and the most frecuent was stomach 9/21. 35 cases the tumor was bilateral the largest dimension was 30 x 20 cm microscopic examination showed variety of patterns.the survival data, follow up and prognosis is bad. CONCLUSIONS: It is important the correct diagnosis of Krukenberg tumor. We recommended frozen section. The prognosis is very poor.

[Pseudopapillary solid tumor of pancreas in the INEN]. / Tumor sólido pseudopapilar de pancreas en el INEN.

OBJECTIVE: To determine the frequency of pancreas solid-pseudopapillary tumor (SPT) and to describe its clinical, pathological and immunohistochemical features in the National Institute of Neoplasic Diseases (INEN). MATERIAL AND METHODS: Cross-sectional, Retrospective and Descriptive study of 28 SPT cases with clinic history, slides and paraffin blocks for the revision and inmunohistochemical examination. Tissue Microarray technique was used and avidin-biotin method in the necessary cases. The statistical processing was made with SPSS 13.0 program. RESULTS: The SPT accounts for 3.7% of pancreatic tumors in the INEN. 24 patients were female (85.7%) and 4 male (14.3%) with average age 25.61years old. Clinically 50% displayed abdominal pain. There was no Ca 19-9 abnormal value. Two metastasis cases were found, one of them died. The average tumor size was 10.0 cm. and the most frequent location was the head of the pancreas. Histologically is a monoforme pattern neoplasia, that displays pseudopapillae, rosettes, cholesterol crystals, sclerosis and calcification. The vascular infiltration, perineural, mitosis and nuclear atipia appeared in malignant cases. Immunohistochemically were vimentin and progesterone positive in the most cases. CONCLUSIONS: SPT is uncommon tumor with clinical, pathological and inmunohistochemical defined features. It is less aggressive than other pancreatic tumors, nevertheless its uncertain behavior demands follow up.

[Pancreatic lipoma: presentation of a case and review of literature]. / Lipoma pancreático: presentación de un caso y revisión de la literatura.

Diagnosis of pancreatic lipoma, is very rare. We presented the case of a 51 years woman who show a tumor of 9x8 cm. at the head and neck of the pancreas. A pancreatoduodenectomy was performed with favorable result. We discuss the therapeutic decision.

Tumor neuroectodermal melanótico de la infancia en los maxilares: reporte de dos casos / Melanotic neuroectodermal tumor of infancy on the jaws report of two cases

El Tumor Neuroectodermal Melanótico de la Infancia (TNMI) es un tumor raro que se presenta en infantes antes de un año de edad. Es un tumor de crecimiento rápido, que afecta el maxilar. En la mayoría de los casos es benigno. Reportamos dos casos atendidos en el Instituto Nacional de Enfermedades Neoplásicas. Los pacientes fueron 2 Infantes, de 4 a 7 meses de edad, en el maxilar inferior y superior respectivamente. En ambos casos se realizó resección quirúrgica del Tumor. El diagnóstico se corrobora con Inmunohistoquímica marcadores S-100 y Sinaptofísina y Panqueratina. La evolución fue favorable y ambos pacientes viven.

Melanotic Neuroectodermal Tumor of Infancy (MNTI) is a rare neoplasm occurring in infants before one year of age. It is a neoplasm of fast growth that affects maxilla. In most of the cases it is benign. We reported two cases attended at the Instituto Nacional de Enfermedades Neoplásicas. The patients were two infants, of 4 and 7 months old, in the mandible and maxilla respectively. In both cases the treatment was surgical excision. The diagnosis is corroborated with Inmunohistochemestry markers, S-100, Sinaptofisin and Pankeratin. The evolution was favorable and both patients are alive.

[Pancreatic cancer and peripancreatic tuberculous lymphadenitis, a case report and literature review]. / Cáncer de páncreas y linfadenitis tuberculosa peripancreática. Reporte de un caso y revisión de la literatura.

Pancreatic tuberculosis and peripancreatic tuberculous lymphadenitis are rare conditions mainly affecting young women, and often occur in endemic areas and immunocompromised patients. The presentation of this condition could be similar to a malign neoplasm. However, coexistence of both pathologies is still very rare and just one case has been reported. A case of synchronism of peripancreatic tuberculous lymphadenitis and pancreatic adenocarcinoma in a 79-year-old woman is presented.

[Paratesticular mixed sarcoma: liposarcoma-rhabdomyosarcoma. Case report and bibliographic review]. / Sarcoma mixto paratesticular: liposarcoma-rabdomiosarcoma. Presentación de un caso y revisión de la literatura.

OBJECTIVE: Sarcomas arising from the urinary tract are rare, representing less than 2% of all urologic tumors. The paratesticular region is one of the most unfrequent locations. Leiomyosarcoma, rhabdomyo-sarcoma, liposarcoma, malignant fibrohistiocytoma, etc. and the combination of two or more histological types has exceptionally been reported. We describe the case of a patient with a mixed paratesticular sarcoma and perform a bibliographic review. METHODS: The patient underwent right radical orchyectomy and the surgical specimen was sent to pathologic study. RESULTS: There are no previous case reports in the literature of paratesticular mixed tumor with liposarcoma and rhabdomyosarcoma. CONCLUSIONS: Sarcomas of the spermatic cord are rare neoplasias and should be considered on the differential diagnosis of scrotal masses. The treatment of choice is surgical and adjuvant treatment must be individualized depending on tumor aggressiveness.

Tumor de células esteroideas de ovario: reporte de un caso y revisión de la literatura / Steroid cell tumor of the ovary: a case report and literature review

El tumor de células esteroideas de ovario es una neoplasia poco frecuente que se origina del estroma o de los cordones sexuales y es potencialmente maligno. La mayoría de estos tumores producen hormonas esteroides siendo la testosterona la que se eleva frecuentemente. Se presenta el caso de una paciente de 30 años que presentó signos de virilización asociado a masa pélvica, ascitis e incremento de la testosterona. Fue operada y sometida a estadiaje de ovario. El resultado del estudio anatomopatológico fue tumor de células esteroideas. Una revisión de los aspectos clínicos, diagnósticos y terapéuticos de estos tumores, es presentada.

Steroid cell tumor of the ovary is a rare malignancy originating from the stromal or sex cord and is potentially malignant. Most of these tumors produce steroid hormones testosterone being which arises frequently. We report a case of a patient 30 who showed signs of virilization associated with pelvic mass, ascites and increased testosterone. She was operated and subjected to ovarian cancer staging. The result of the pathology was steroid cell tumor. A review of clinical aspects, diagnostic, and treatment of these tumors, is presented.

Metástasis de carcinoma de estómago que simula cáncer primario de ovario: importancia de la biopsia por congelación / Metastasis of carcinoma of stomach cancer simulating primary ovarian tumor: importance of frozen biopsies

Objetivo: Importancia de la Bíopsia por congelación en el diagnóstico y manejo de las pacientes con tumores de ovario. Resultados: Comunicamos nueve casos de pacientes con tumores de ovario.El carcinoma primario se encontró durante la operación programada para resección del tumor de ovario.En estos casos durante el acto operatorio y por la biopsia por congelación se hizo diagnóstico de tumor de krukenberg y el carcinoma primario se encontró en el estómago. Conclusiones: El resultado del estudio de nueve pacientes con carcinoma gástrico que simulaba cancer primario de ovario, muestra la importancia de la biopsia por congelación y la comunicación con los médicos cirujanos durante el acto operatorio.

Objetive: The importance of frozen section in the Diagnosis and manegment of patients with ovarian tumors. Results: We report 9 cases of patients with ovary tumors. The primary carcinoma was found during an operation for the ovarian tumor. In these cases the diagnosis of krukenberg tumor was made intraoperatively by frozen section evaluation and the primary carcinoma were found in the stomach. Conclusions: The results of the study of 9 patients with metástasis from gastric carcinoma simulating primary carcinoma of the ovary show us the importance of frozen section and the comunication with the surgeon intraoperatively.

Factores de sobrevida en 152 pacientes con tumores estromales gastrointestinales / Survival factors in 152 patients with gastrointestinal stromal tumors

INTRODUCCIÓN: El tumor estromal gastrointestinal (GIST), es la designación para un tipo específico de tumor mesenquimal del tracto digestivo que proviene de las células intersticiales de Cajal (ICC) o de sus precursores multipotenciales, es de presentación infrecuente y por ello, su mejor conocimiento deberá incidir en un adecuado manejo diagnóstico y terapéutico. OBJETIVOS: Valorar las características clínicas e identificar los factores que influencian la sobrevida de los pacientes con diagnóstico de tumor estromal gastrointestinal. MATERIAL Y MÉTODOS: El presente estudio es de diseño cuantitativo, no experimental, descriptivo, retrospectivo y transversal. Ha sido realizado en 152 pacientes con diagnóstico de tumor estromal gastrointestinal que fueron atendidos en el Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima-Perú, desde Enero del año 1999 hasta Diciembre del año 2009. Para el diagnóstico definitivo se consignó el resultado de la pieza quirúrgica y la histología se complementó con test de inmuno histoquímica. Para valorar la distribución normal de la población se usaron las pruebas de Shapiro-Wolk, Anderson-Darling, Lilliefors, respecto a la estadística inferencial se usó tablas de supervivencia y para valorar la significancia en el análisis univariado (p<0.05 significativa), se usaronlas pruebas de Wilcoxon, Tarone-ware y Log-rank, además para evaluar la diferencia entre grupos en las tablas de contingencia se utilizó el chi cuadrado y el test de Fisher. El análisis multivariado se realizó utilizando el modelo de riesgo proporcional de Cox.RESULTADOS: El grupo de 152 pacientes comprendió 78 mujeres (51%) y 74 varones (49%) con rango etáreo de 16 a 92 años, con una edad promedio de 54 años. La frecuencia de presentación se incrementó a partir de la cuarta década de vida y alcanzó su mayor expresión entre los 50 y 70 años. La presentación inicial fue de enfermedad localizada para 79 pacientes (52%) y con metástasis primaria...

INTRODUCTION: The gastrointestinal stromal tumor (GIST) is the designation for a specific type of mesenchymal tumor of the digestive tract that is origin in the interstitial cells of Cajal (ICC) or its precursor multipotentials, its presentation is rare and therefore its best knowledge must affect a proper diagnosis and treatment. OBJECTIVES: To evaluate the clinical characteristics and to identify factors influencing survival of patients with gastrointestinal stromal tumor. MATERIAL AND METHODS: This study design is quantitative, non experimental, descriptive, retrospective and transversal. The study has been performed in 152 patients with gastrointestinal stromal tumor who were treated at the National Institute of Neoplastic Diseases (INEN), Lima, Peru, from January 1999 through December 2009. For the final diagnosis was registered the outcome of the surgical and histology was complemented by immunohistochemical test. To assess the normal distribution of the population was used the Shapiro-Wolk, Anderson-Darling, Lilliefors, regarding the use of inferential statistical tables for survival and to assess its significance in the univariate analysis (p<0.05 significance), was used the Wilcoxon test, Tarone-Ware Log-rank and also to evaluate the difference between groups in contingency tables used the chi square and FisherÆs test. Multivariate analysis was performed using the proportional hazards model of Cox. RESULTS: The group of 152 patients included 78 women (51%) and 74 men (49%) with age range from 16 to 92 years, with an average age of 54. The frequency presentation was increased from the fourth decade of life and reaches its highest expression between 50 and 70. The initial presentation was with localized disease to 79 patients (52%) and primary metastases in 73 patients (48%), with an average time of disease 14 months. The prevalence of GIST tumor in the differents organs was as follows: stomach with 77 patients (50.65%), jejunum with 21 patients...

Tumor carcinoide del recto: correlación clínico-patológica / Carcinoid tumors of the rectum: clinical - pathological correlation

OBJETIVO: El propósito del estudio fue establecer la correlación clínico-patológica del tumor carcinoide del recto en los pacientes del Instituto Nacional de Enfermedades Neoplásicas (INEN)MATERIALES Y MÉTODOS: Se revisan las historias clínicas así como el estudio anatomo-patológico de los tumores carcinoides de 20 pacientes del Instituto Nacional de Enfermedades Neoplásicas (INEN) entre los años de 1980 al 2006. RESULTADOS: No se encontró diferencias en cuanto al sexo: En los 11 pacientes tuvieron tumores mayores de 2 cm. 12 pacientes tuvieron metástasis. 8 pacientes sin metástasis, los tumores medían menos de 2 cm. 6 pacientes tuvieron resección endoscópica, la mayoría de los tumores eran polipoides medían menos de 2 cm y eran típicos. 7 casos fueron histológicamente atípicos, 2 de ellos fallecieron, todos tenian metástasis y los tumores median de 3 a 6 cm. CONCLUSIONES: El tamaño del tumor, la patología atípica, la infiltración de la pared y las metástasis estan asociados a conducta agresiva y mal pronóstico.

OBJETIVE: The purpose of this study was to determine the clinico-pathologic correlation of carcinoid tumors of the rectum. MATERIALS AND METHODS: We reviewed the medical records and pathology of 20 patients with carcinoid tumors of the rectum seen at the Instituto de Enfermedades Neoplásicas (INEN), between 1980 and 2006RESULTS: There was no difference between sex. 11 patients had tumors over 2 cm. 12 had metastasis. 8 patients without metastasis had, tumors size of less than 2 cm. 6 pacients had endoscopic resection, the tumors were often polypoid, the size less than 2 cm and with typical histopathologic. 7 cases hat atypical histopathologic from them 2 patients dead, all had metastasis and tumor sizes were 3 to 6 cm. CONCLUSIONS: The tumor size, the atypical histopathologic features, the infiltration of the wall and metastasis are associated with aggressive behavior and bad prognosis.

Tumor de Krukenberg del ovario: estudio clínico patológico de 56 casos en el Instituto Nacional de Enfermedades Neoplásicas / Krukenberg ovary tumor pathological clinical study of 56 cases in the Instituto Nacional de Enfermedades Neoplásicas (National Cancer Institute)

OBJETIVO: Se estudian 56 casos de tumor de Krukenberg del ovario en el Instituto Nacional de Enfermedades Neoplásicas en relación al diagnóstico microscópico, origen primario y correlación clínico-patológica. RESULTADOS: La edad de las pacientes varía de 18 a 84 años. El primario conocido mas frecuente es el estómago 33 (58.9%) casos. Los datos clínicos frecuentes son dolory distensión abdominal, ascitis y hemorragia vaginal. 21 pacientes tuvieron biopsias por congelación. En 11 (52.3%) se establece el primario durante el acto operatorio (estómago 9/21). En 35 casos el tumor fue bilateral. El tumor mas grande fue de 30 x 20 cm. Microscópicamente pueden presentar varios patrones. La sobrevida, seguimiento y pronóstico de las pacientes es malo. CONCLUSIONES: Es importante el diagnóstico correcto del tumor de Krukenberg de ovario siendo mejor en biopsias por congelación. El pronóstico es malo.

OBJETIVE: We report 56 cases of ovary Krukenberg tumor at Instituto Nacional de Enfermedades Neoplásicas en relation to microscopic diagnosis, primary origin and clinicopathologic correlation. RESULTS: The patients ranged from 18 to 84 years. the most frecuent primary tumor was stomach 33 (58.9%) cases. Abdominal swelling and pain usually accounted for the clinical presentation. Ascitis, abnormal vaginal bleeding. 21 patients had frozen section. 11(52.3%) cases the primary carcinoma was found during an operation for the ovary tumor and the most frecuent was stomach 9/21. 35 cases the tumor was bilateral the largest dimension was 30 x 20 cm microscopic examination showed variety of patterns, the survival data, follow up and prognosis is bad. CONCLUSIONS: It is important the correct diagnosis of Krukenberg tumor. We recomended frozen section. The prognosis is very poor.

[Colon and rectum signet-ring cell carcinoma in the National Institute of Neoplastic Diseases]. / Carcinoma de celulas en anillo de sello del colon y recto en el Instituto Nacional de Enfermedades Neoplasicas.

OBJECTIVE: Primary signet ring cell carcinoma of the colon and rectum is a rare form of adenocarcinoma of the large intestine. The purpose of this study was define the incidence, natural history and relation with hereditary nonpolyposis colorectal cancer (HNPCC). METHODS: We reviewed the medical records and pathology of 28 patients with primary signet ring cell carcinoma of the colon and rectum seen at the Instituto de Enfermedades Neoplasicas (INEN), between 1991 and 2002. RESULTS: In the present study the incidence was 5.09% of large bowel adenocarcinoma. Most patients present with late stage disease (Dukes stage C and D). In most cases the signet ring cells diffusely infiltrated through all layers of the intestinal wall (Borrmann IV). Male to female ratio was of 1 : 1.5, mean age was 55.5 and median age was 57 years (range 11 - 83 years). CONCLUSIONS: Comparison of our data with the literature showed some differences that could be related with biological characteristics of our people and different applied inclusion criteria. We couldn't define the relation between HNPCC and primary signet ring cell carcinoma of the colon and rectum.

[Barrett's esophagus]. / Esófago de barrett.

The first part of this report reviews the definition, history and clinical aspects of Barrett s Esophagus. The next section explains the results obtained at INEN, Lima Peru. The first case of Barrett s Esophagus complicated with Adenocarcinoma was diagnosed in 1956. The prevalence of Barrett s Esophagus in 3,904 patients who were administered endoscopy examinations is 0.64%. The evaluation of 40 patients with Barrett s Esophagus indicated that it has a greater incidence in males than in females (3:1). The average age of patients with Barrett s Esophagus is 60 years and its incidence increases as they grow older. It manifests itself in 40 year old persons and is specially strong from 55 to 64 years of age. Dysplasia is associated with Intestinal Metaplasia. The frequency of the epidermoid carcinoma is of 96% and for adenocarcinoma of 4% in the period of evaluation of 15 years (1985-1999). There is no difference in the tendency of epidermoid carcinoma and esophagus adenocarcinoma during the same evaluation period. The incidence of Barrett s Esophagus adenocarcinoma is higher in males than in females: (6:1). Intestinal metaplasia is found in 13/14 patients evaluated in relation to the esophagus adenocarcinoma. Long segment Barrett s Esophagus, is found in 13/14 patients complicated with adenocarcinoma. The average size of the long segment Barrett s Esophagus is of 6 cm in the patients with adenocarcinoma.

Disección submucosa y mucosectomía en el tratamiento de las neoplasias intraepiteliales y del cáncer gástrico temprano / Endoscopic submucosal dissection and mucosectomy for the treatment of the epithelial neoplasia and early gastric cancer

Introducción: La resección endoscópica llamada mucosectomía y la disección submucosa del cáncer gástrico temprano, han permitido en el Japón, el tratamiento de variedades de cáncer con preservación del órgano y con intención curativa, específicamente para aquellos pacientes que tienen posibilidad nula o remota de compromiso con metástasis ganglionar. Objetivos: Determinar en nuestro medio la efectividad de la mucosectomía para el tratamiento del cáncer gástrico temprano y evaluar la extensión de la indicación para las neoplasias intraepiteliales de alto y bajo grado (adenomas/displasias de alto y bajo grado), así como la pertinencia de su indicación para las lesiones tipo 0, sin neoplasia epitelial. Valorar la utilidad y factibilidad de la disección submucosa con el needle knife. Material y Métodos: El presente estudio es de tipo prospectivo, observacional (no experimental), analítico y de corte longitudinal. Se realizó en 96 pacientes incidentes con diagnóstico de lesiones gástricas tipo 0 elevadas, planas y deprimidas que fueron atendidos en el Servicio de Gastroenterología del Instituto Nacional de Enfermedades Neoplásicas (INEN), desde enero de 1996 hasta octubre de 2008. Se utilizó la clasificación modificada de Viena para las neoplasias epiteliales gastrointestinales dentro de la evaluación y manejo de las lesiones tipo 0. Se utilizó la clasificación proveída por el Comité de Endoscopía Quirúrgica de la Sociedad Japonesa para la investigación del Cáncer Gástrico para definir la indicación de la resección endoscópica de la mucosa como tratamiento radical del Cáncer Gástrico Temprano. Las lesiones fueron resecadas con el asa simple de polipectomía, la utilización del cap de Olympus y el needle knife para la disección submucosa. La combinación empleada para lograr el habón en la submucosa fue de solución salina y adrenalina o de solución salina y agua destilada. En el análisis estadístico se utilizó el programa SPPS-12 para la obtención de los ...

Introduction: In Japan, endoscopic mucosal resection and endoscopic submucosal dissection of early gastric cancer are accepted as a treatment options for cases of early gastric cancer where the probability of lymph node metastasis is nil or low. Objectives: To establish the effectiveness of mucosectomy for the treatment of earlygastric cancer and evaluate the extended indications for dysplasia lesions, also, we want to determine if the mucosectomy is relevant for lesions negative for neoplasia at the National Institute for Neoplastic Diseases (INEN), Lima, Peru. We call for estimating the utility and factibility of the endoscopic submucosa dissection with the needle knife. Materials and Methods: The study is an observational, prospective, analytical and cross longitudinal. The study was performed in 96 patients with Type 0 Neoplastic lesions at INEN from 1996 to 2008. The revised Vienna classification of gastrointestinal epithelial neoplasia was utilized. The indication for endoscopic mucosal resection as a radical treatment of early gastric cancer is according to the treatment guidelines for gastriccancer in Japan. The lesions were resected with a simple endoscopic snare, with the Olympus cap for some depressed lesions and the needle knife during the submucosal dissection. Lifting of the lesion with submucosal injection was done with saline solution with epinephrine or saline with distillate water. The statistical analysis included the SPPS-12 programme. Results: 96 patients were treated by mucosectomy and endoscopic submucosal dissectionfrom 1996 to 2008. The sample represents patients with a mean age over 50 years old and predominance of female. 55 patients belongs to category 1 of revised Vienna Classification, 9 patients are in the category 3, 31 patients are suitable in category 4 (20 with high grade adenoma/dysplasia and 11 with intramucosal carcinoma) and just 1 patient for the category 5. We resected 305 Type 0 lesions, ...

Tumor sólido pseudopapilar de páncreas en el Instituto Nacional de Enfermedades Neoplásicas / Pseudopapillary solid tumor of pancreas in the INEN

Objetivo: Determinar en el Instituto Nacional de Enfermedades Neoplásicas (INEN) la frecuencia del tumor sólido pseudo-papilar de páncreas (TSP) e identificar sus características clínicas, patológicas e inmunohistoquímicas. MATERIALES Y MÉTODOS: Estudio descriptivo, retrospectivo, transversal de 28 casos de TSP, que contaban con historia clínica, láminas y tacos de parafina para la revisión y estudio inmunohistoquímico. Se utilizó la técnica de Tissue Microarray y el método avidina-biotina. Las determinaciones estadísticas se hicieron con el programa SPSS 13.0. RESULTADOS: El TSP representa el 3.7 por ciento de las neoplasias pancreáticas en el INEN. 24 pacientes fueron mujeres (85.7 por ciento) y 4 varones (14.3 por ciento) con una edad promedio de 25.61 años. Clínicamente el 50 por ciento presentó dolor abdominal. No existió ningún valoranormal de Ca 19-9. Se encontraron dos casos de metástasis, uno de ellos falleció. El tamaño tumoral promedio fue 10.0 cm. y la localización más frecuente la cabeza de páncreas. Histológicamente es una neoplasia de patrón monomorfico, que presenta pseudopapilas, rosetas, cristales de colesterol, esclerosis y calcificación. La infiltración vascular, perineural, mitosis y atipia nuclear se presentaron en los casos de malignidad. Inmunohistoquimicamente la mayoría fueron vimentina y progesterona positivos CONCLUSIONES: El TSP es un tumor raro con características clínicas, patológicas e inmunohistoquímicas definidas es menos agresivo que otros tumores pancreáticos, sin embargo su comportamiento incierto exige seguimiento.

OBJECTIVE: To determine the frequency of pancreas solid-pseudopapillary tumor (SPT) and to describe its clinical, pathological and immunohistochemical features in the National Institute of Neoplasic Diseases (INEN). MATERIAL AND METHODS: Cross-sectional, Retrospective and Descriptive study of 28 SPT cases with clinic history, slides and paraffin blocks for the revision and inmunohistochemical examination. Tissue Microarray technique was used and avidin-biotin method in the necesary cases. The statistical processing was made with SPSS 13.0 program. RESULTS: The SPT accounts for 3.7 per cent of pancreatic tumors in the INEN. 24 patients were female (85.7 per cent) and 4 male (14.3 per cent) with average age 25.61 years old. Clinically 50 per cent displayed abdominal pain. There was no Ca 19-9 abnormal value. Two metastasis cases were found, one of them died. The average tumor size was 10.0 cm. and the most frequentlocation was the head of the pancreas. Histologically is a monoforme pattern neoplasia, that displays pseudopapillae, rosettes, cholesterol crystals, sclerosis and calcification. The vascular infiltration, perineural, mitosis and nuclear atipia appeared in malignant cases. Immunohistochemically were vimentin and progesterone positive in the most cases. CONCLUSIONS: SPT is uncommon tumor with clinical, pathological and inmunohistochemical defined features. It is less aggressive than other pancreatic tumors, nevertheless its uncertain behavior demands follow up.

Lipoma pancreático: presentación de un caso y revisión de la literatura / Pancreatic lipoma: presentation of a case and review of literature

El diagnóstico de lipoma pancreático, es muy poco frecuente. Presentamos el caso de una mujer de 51 años con una lesión de 9 por 8 cm. A nivel de la cabeza y cuello del páncreas, a quien se le realizó una pancreatoduodenectomia proximal. Se discute la decisión terapéutica.

Diagnosis of pancreatic lipoma, is very rare. We presented the case of a 51 years woman who show a tumour of 9x8 cm. at the head and neck of the pancreas. A pancreatoduodenectomy was performed with favourable evolution. We discuss the therapeutic decision.