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An analysis of the prognostic impact of up to 36 immuno-inflammatory indices at 3 different times during the diagnostic-therapeutic process for gastric cancer. The dependent variable was disease-free survival at 3 years. The independent factors obtained were combined with TNM to provide an improved prognostic model.
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Neoplasias Gástricas , Humanos , Neoplasias Gástricas/patologia , Prognóstico , Projetos Piloto , Estadiamento de Neoplasias , Intervalo Livre de Doença , Estudos RetrospectivosRESUMO
Endoscopic retrograde cholangiopancreatography (ERCP) performed in situations of altered anatomy has been described. Thus, in cases of Roux-en-Y gastric by-pass, several approaches have been documented for performing ERCP: by enteroscopy, guided by laparoscopic approach through the gastric remnant, and direct transgastric guided by endoscopic ultrasound through a stent between the reservoir or alimentary loop and the gastric remnant. However, there are clinical situations in which the anatomy is not altered, but there may be pancreatic lesions subsidiary to study by endoscopic ultrasound in situations where the endoscope cannot pass through the esophagus. Therefore, we present the clinical case of a patient with a pancreatic lesion subsidiary to study and a distal esophageal adenocarcinoma that prevented the passage of the endoscope.
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The relationship of proton pump inhibitors (PPIs) with gastric cancer is not clear. However, more and more patients with gastroesophageal reflux disease (GERD) who are candidates for therapy with PPIs reject such treatment. This situation is largely caused by global access to information, especially on the internet, where some news has recently been published linking PPIs to the development of gastric cancer. For this reason, patients with GERD who are candidates for therapy with PPIs, before rejecting such treatment and opting for antireflux surgery, should be aware of the morbidity and mortality of the surgery and the current scientific evidence regarding the relationship between PPIs and gastric cancer.
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Lymphoepithelioma-like gastric adenocarcinoma is characterised by a large reactive lymphoplasmacytic infiltrate in the stroma and islets of undifferentiated cells, which express intense and widespread Epstein-Barr virus (EBV). This tumour type has higher survival rates than other gastric cancers, a more proximal location and less lymphatic spread. Our aim is to describe the clinical and pathological characteristics of our series of lymphoepithelioma-like gastric adenocarcinoma. We selected patients who underwent surgery for gastric adenocarcinoma lymphoepithelioma-like variant from 2014 onwards. The results of the following variables were collected: age (years), sex, pre-diagnostic clinical time (months), gastric tumour location, endoscopic biopsy histology, surgical technique, in situ hybridisation for EBER region (Epstein-Barr virus-associated non-coding RNA), microsatellite instability, degree of differentiation, level of resection, tumour size (cm), TNM T value, lymphadenopathy/resected node ratio, overall survival (months) and vital status. Our experience in the lymphoepithelioma-like variant presents as an advanced gastric cancer, possibly related to long-standing prediagnostic symptoms. It behaves as a tumour with expansive local growth with little capacity for lymphatic or metastatic involvement, which could be explained by the prominent intratumoral lymphoid stroma that acts as an antimetastatic barrier.
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We present the third case described to date of large cell neuroendocrine carcinoma located at the esophagogastric junction (LCNEC). Esophageal neuroendocrine tumours account for 0.03-0.05% of all malignant esophageal tumours. Within oesophageal NETs, LCNEC accounts for 1% of esophageal NETs. This tumour type is characterised by elevated levels of certain markers: synaptophysin, chromogranin A and CD56. In fact, 100% of patients will have chromogranin or synaptophysin, or at least one of these three markers. In turn, 78% will have lymphovascular invasion and 26% will have perineural invasion. Only 11% of patients will have stage I-II, which implies an aggressive course and worse prognosis.
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Biomarcadores Tumorais , Carcinoma Neuroendócrino , Humanos , Sinaptofisina/metabolismo , Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Neuroendócrino/patologia , Junção Esofagogástrica/patologiaRESUMO
Although morphology is the key to histological diagnosis, gastric mesenchymal tumors can share very similar growth and cellularity patterns, sometimes being indistinguishable. Therefore, immunohistochemical techniques are going to be crucial in the definitive diagnosis. The objective of this work is to perform an immunohistochemical differential diagnosis of gastric mesenchymal tumors.
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Neoplasias Gástricas , Humanos , Imuno-Histoquímica , Diagnóstico Diferencial , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologiaRESUMO
Streptococcus constellatus is a Gram-positive commensal bacterium of the oropharyngeal, gastrointestinal and urogenital flora. It can cause abscesses in different parts of the body, especially in immunocompromised patients. We present the clinical case of a 33-year-old female patient with a previous history of one anastomosis gastric bypass, among others. The patient was hospitalized two years after surgery for peritonitis secondary to a perforation in the biliopancreatic loop, underwent laparoscopic surgery and was hospitalised for two weeks. Fifteen days after being discharged from the hospital, she went to the emergency service for abdominal pain and fever. An abdominal and pelvic computerized tomography (CT) scan showed a multiloculated pelvic collection with thickened and hypercapillary walls.
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Abscesso Abdominal , Peritonite , Streptococcus constellatus , Feminino , Humanos , Adulto , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/cirurgia , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Abscesso/etiologia , Dor Abdominal/etiologia , Peritonite/diagnóstico por imagem , Peritonite/etiologia , Peritonite/cirurgiaRESUMO
Gastric neuroendocrine tumors (GNETs) account for less than 2% of gastric neoplasms and type 1 GNETs (GNETs-1), which are associated with chronic atrophic gastritis, account for 70-80% of all GNETs. Treatment of GNETs-1 is usually endoscopic, but surgery also has its indications. The aim of this study is to present five case reports of GNETs-1 treated with surgery and to analyze the surgical indications for this type of tumors.
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Gastric schwannoma can be malignant in 13.8% of cases. The prognosis of malignant schwannoma is usually poor, characterized by a rapidly progressive disease course and a poor response to chemotherapy. Normally, the recurrence of schwannoma is due to involvement of the surgical resection margin. In turn, recurrence of malignant gastric schwannoma GS is approximately 50%, 25% locoregional and 25% with liver metastases. Even after a complete gastric resection with associated lymphadenectomy, schwannoma may present liver metastases during follow-up.
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Neoplasias Hepáticas , Neurilemoma , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/patologia , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Prognóstico , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/secundário , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologiaRESUMO
We report the case of a 65-year-old male with hypertension, diabetes and hypercholesterolemia, who presented due to pyrosis and regurgitation. A CT scan incidentally identified esophageal compression at two sites because of vascular abnormalities, which was asymptomatic. The proximal compression was due to a Kommerell's diverticulum (Fig. 1) and the distal one due to aortic tortuosity (Fig. 2). Esophageal manometry revealed a distal obstructive pattern of mechanical origin, which was consistent with the observed aortic kink. The esophagogram (Fig. 3) showed a proximal filling defect and a bend in the distal third.
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Anormalidades Cardiovasculares , Divertículo , Idoso , Aorta Torácica , Anormalidades Cardiovasculares/complicações , Divertículo/complicações , Humanos , Masculino , Artéria Subclávia , Tomografia Computadorizada por Raios XRESUMO
We have read with interest the article by Pérez Montiel CA et al., in which goblet cell adenocarcinoma (GCA) is described as a cause of acute appendicitis. Although the article is brilliant in terms of histopathological description of the appendiceal GCA, the surgical indication for right hemicolectomy should be analyzed in depth due to the great controversy that exists in the scientific literature.
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Adenocarcinoma , Neoplasias do Apêndice , Apendicite , Apêndice , Tumor Carcinoide , Doença Aguda , Adenocarcinoma/complicações , Adenocarcinoma/cirurgia , Neoplasias do Apêndice/complicações , Apendicite/cirurgia , Apêndice/patologia , Tumor Carcinoide/complicações , Colectomia/efeitos adversos , Células Caliciformes/patologia , HumanosRESUMO
We read with interest the article by Garrido Durán C, et al. in which endoscopic aspects of duodenal levodopa/carbidopa therapy in the treatment of advanced Parkinson's disease were analyzed. In this article, buried bumper syndrome (BBS) is documented in 5.4 % of cases. Normally, the initial treatment of BBS is endoscopic therapy, although sometimes surgery may be necessary. Thus, 4 cases of BBS treated with surgery are presented.
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Carbidopa , Doença de Parkinson , Antiparkinsonianos/efeitos adversos , Carbidopa/efeitos adversos , Combinação de Medicamentos , Nutrição Enteral , Gastrostomia , Humanos , Levodopa/efeitos adversos , Doença de Parkinson/tratamento farmacológicoRESUMO
INTRODUCTION: Bariatric surgery improves sexual function in obese individuals, although the extent to which sexual satisfaction is improved following surgery is unknown. The aims of this study were 1) to describe sexual satisfaction in severely/morbidly obese men and women candidates for bariatric surgery; 2) to assess the effects of bariatric surgery on sexual satisfaction at 12-months follow-up; and 3) to assess whether weight changes at follow-up following bariatric surgery are associated with changes in sexual satisfaction. METHODS: We conducted a prospective observational study from February 2011 to June 2014. A total of 44 patients with severe/morbid obesity participated in the study. Sexual satisfaction was assessed (at baseline and 12-months follow-up) through the Index of Sexual Satisfaction (ISS) questionnaire. RESULTS: Of 44 patients who completed the ISS at baseline (mean age 40.3 [SD=9.4] years and BMI 46.9 [SD=6.2] kg/m2), 17 were lost to follow-up. The baseline ISS total scores were 32.0 (SD=20.1) in women and 24.4 (SD=16.0) in men (P>0.05). The proportion of sexually satisfied men and women at baseline was 62.5% and 46.4%, respectively (P=0.360). At follow-up, sexual satisfaction improved significantly in women (average difference 13.7 units; P=0.032) but not in men (average difference 3.6 units; P=0.717). The percentage of women with sexual satisfaction problems was reduced by 33% at follow-up (P=0.038). CONCLUSIONS: A relatively large percentage of severely/morbidly obese women and men present clinically significant sexual satisfaction problems before undergoing bariatric surgery. Sexual satisfaction improves significantly 12 months following bariatric surgery, particularly in women.
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Cirurgia Bariátrica , Obesidade Mórbida/cirurgia , Orgasmo , Adulto , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
INTRODUCTION: Transanal endoscopic microsurgery (TEM) was developed as a less aggressive alternative treatment for rectal lesions (mainly adenomas and adenocarcinomas). However, its use for other rectal lesions has become more frequent, trying to reduce the morbidity associated with more invasive techniques. The aim of this study is to describe our experience in the use of TEM in other rectal lesions. METHODS: Retrospective and descriptive study including patients operated with TEM (from June 2008 to December 2016) for the treatment of rectal lesions different from adenomas or adenocarcinomas. RESULTS: Among the 138 patients treated by TEM in our department, 10 patients were operated on for rectal lesions other than adenomas or adenocarcinomas. Rectal lesions were 3neuroendocrine tumours, a neuroendocrine tumour metastasis, a rectal stenosis, a cloacogenic polyp, an endometrioma, a retrorrectal tumour, a presacral abscess and a lesion in the rectovaginal septum. Mean operative time was 72min and postoperative stay was 4.2 days. Only one patient needed a reoperation, due to rectal bleeding. CONCLUSIONS: TEM could be a useful tool for the treatment of rectal lesions different from adenomas or adenocarcinomas, potentially decreasing the morbidity associated with more aggressive surgical techniques.