Vegetating lesions that appear in the scar after neoadjuvant therapy for rectal tumors: tumor regrowth or benign neoplasm?

Introduction: After the diagnosis of neoplasm of the middle and distal rectum, patients are often submitted to oncological treatment by neoadjuvant therapy. At the end of this treatment, those patients who show complete clinical response can choose, together with their physician, to adopt the watch-and-wait strategy; although it implies lower morbidity for the patient, this strategy is dependent on strict adherence to treatment follow-up for the early identification of any future local injury. Materials and Methods: Survey of data from medical records and description, and discussion of case reports with a literature review in books and databases. Results: We report the case of a 73-year-old patient diagnosed with moderately differentiated adenocarcinoma of the middle rectum, Stage II (cT3bN0M0), who presented complete clinical response after undergoing treatment with neoadjuvant therapy. Together with the assistant team, the watch-and-wait strategy was chosen. During the follow-up, an endoscopic examination showed a vegetating at the proximal limit of the tumor scar. We chose to perform submucosal endoscopic dissection. The report of the anatomopathological examination evidenced a serrated adenoma with narrow margins free of neoplasia. Conclusion: Patient adherence to cancer treatment using the watch-and-wait strategy is essential for the early identification of new local lesions. After resection of the lesion identified in the tumor scar site as a neoplasm-free lesion, it is consistent to think that this lesion would be the origin of the neoplasm, given the adenomatous origin. (AU)

Neoplasia cística mucinosa do pâncreas / Mucinous cystic neoplasia of the pancreas

Introdução: Neoplasia cística mucinosa é tumor mucinoso benigno (cistoadenoma mucinoso) ou maligno (cistoadenocarcinoma mucinoso), que não se comunica com os ductos pancreáticos. Objetivo: Apresentar revisão da literatura sobre o tema. Método: Ênfase nas diretrizes das principais sociedades médicas mundiais na orientação do diagnóstico, tratamento e a vigilância da neoplasia cística mucinosa. Resultado: A quase totalidade dessas neoplasias ocorre no gênero feminino de 40-50 anos de idade. Como raras exceções, esta neoplasia é encontrada na cauda/corpo do pâncreas. Para estabelecer o diagnóstico é necessário a presença de estroma similar ao do ovário na parede do cisto no exame patológico. Exames de imagem de alta resolução, como tomografia, ressonância magnética e ecoendoscopia apresentam elevada precisão para identificar esta neoplasia. O tratamento cirúrgico consiste na pancreatectomia distal com linfadenectomia e esplenectomia. A via laparoscópica ou robótica é preferida para tumores <5-7 cm. Devido a possibilidade de rotura do tumor e disseminação da neoplasia, as lesões >5-7 cm devem ser submetidos à ressecção laparotômica. Conclusão: Não existe uniformidade internacional na conduta terapêutica. O tratamento cirúrgico deve ser indicado para todos os pacientes com condições cirúrgicas e que apresentam neoplasia ≥3-4 cm, dependendo do consenso.

Introduction: Mucinous cystic neoplasia is a benign mucinous tumor (mucinous cystadenoma) or malignant (mucinous cystadenocarcinoma), which does not communicate with the pancreatic ducts. Objective: To present a review of the literature on the topic. Method: Emphasis on the guidelines of the main global medical societies in guiding the diagnosis, treatment and surveillance of mucinous cystic neoplasia. Result: Almost all of these neoplasms occur in females aged 40-50 years. As a rare exception, this neoplasm is found in the tail/body of the pancreas. To establish the diagnosis, the presence of stroma similar to that of the ovary in the cyst wall is necessary on pathological examination. High-resolution imaging exams, such as tomography, magnetic resonance imaging and endoscopic ultrasound, are highly accurate in identifying this neoplasm. Surgical treatment consists of distal pancreatectomy with lymphadenectomy and splenectomy. The laparoscopic or robotic route is preferred for tumors <5-7 cm. Due to the possibility of tumor rupture and dissemination of the neoplasm, lesions >5-7 cm must undergo laparotomic resection. Conclusion: There is no international uniformity in therapeutic conduct. Surgical treatment should be indicated for all patients with surgical conditions and who have neoplasia ≥3-4 cm, depending on the consensus.