ABSTRACT
Digestive endoscopy is the method for detection and biopsy of epitelial lesions in the gastrointestinal tract. Endoscopic ultrasound (EUS) is a supplement to define endoscopic findings. It helps for the visualization of the GI tract levels with a demonstrated histological correlation, which allows the stratification of the depth (T of the TNM classification). EUS can assess the surroundings of the digestive tract, identifying adenopathies, ascitis and lesions in the left lobe of the liver, as well as tumoral extension to neighboring organs. Fine needle aspiration (FNA) adds the possibility for cytohistological diagnosis of the depth of the GI tract wall and the surrounding structures. EUS accuracy for establishing T in the cancer of GI tract wall varies between 73-95 percent, and N between 70-90 percent. Associating of computed tomography (CT) with EUS results in a more accurate diagnosis. In incipient cancer therapy, EUS plays a role in T and N diagnosis, by selecting or discharging patients for the performance of minimally invasive techniques: ESD (endoscopic submucosal disection), EMR (endoscopic mucosal resection) or polipectomy, specially when no sample is obtained for histology analysis (ablation with Argon plasma coagulation, radiofrequency or heat). In advanced digestive cancer accuracy for stratification helps to choose the most appropriate procedure: resection, palliative care or surgery.
La endoscopia digestiva es el método de detección y biopsia de lesiones epiteliales del tubo gastrointestinal. La endosonografía (EUS = endoscopic ultrasound) es un complemento para definir los hallazgos endoscópicos. Tiene la capacidad de visualizar los estratos del tubo digestivo con una correlación histológica demostrada, lo que permite su uso en la etapificación del compromiso en profundidad (T de la clasificación TNM). La EUS puede evaluar la periferia del tubo digestivo, identificando adenopatías, presencia de ascitis y de lesiones en el lóbulo izquierdo hepático, como también la extensión tumoral a órganos vecinos. La punción aspiración con aguja fina, EUS FNA (FNA = fine needle aspiration), agrega la posibilidad de diagnóstico citohistológico de la profundidad de la pared del tubo digestivo o de las estructuras en su periferia. La precisión de la EUS en establecer T en el cáncer de la pared del tubo digestivo varía entre 73- 95 por ciento y N entre 70-90 por ciento. La asociación de tomografía computada (TC) con EUS logra en su conjunto el diagnóstico más preciso. En la terapia del cáncer incipiente, la EUS cumple un rol en el diagnóstico de T y N, seleccionando o descartando pacientes para la realización de técnicas mínimamente invasivas: ESD (endoscopic submucosal disection), REM (resección endoscópica de la mucosa-endoscopic mucosal resection) o polipectomía, especialmente cuando no se obtiene muestra para histología (ablación con coagulación con Argón, radiofrecuencia o calor). En el cáncer digestivo avanzado la etapificación precisa ayuda a decidir la conducta más adecuada, resectiva o paliativa, endoscópica o quirúrgica.
Subject(s)
Humans , Endosonography/methods , Esophageal Neoplasms/pathology , Esophageal Neoplasms , Stomach Neoplasms/pathology , Stomach Neoplasms , Endosonography , Neoplasm Staging/methodsABSTRACT
Background: Autoimmune pancreatitis is a special form of chronic pancreatitis, more common in men and usually presenting as obstructive jaundice or abdominal pain. It may be associated with other immunological disorders and sometimes it is possible to find positive serological markers. Typical images show pancreatic enlargement with focal or diffuse stenosis of the pancreatic duct but sometimes it presents as a focal pancreatic mass that is difficult to differentiate from pancreatic carcinoma. Aim: To report ten cases of autoimmune pancreatitis. Material and Methods: Retrospective review of clinical records of 10 patients aged 26 to 56 years (six males) with autoimmune pancreatitis. Results: The clinical presentation was obstructive jaundice in six cases, acute pancreatitis in two, persistent increase in serum amylase and Upase in one, and permanent abdominal pain and weight loss in one. On imaging studies, a circumscribed mass was founded in six patients. An endoscopic retrograde colangiopancreatography was performed in four patients showing an abnormal pancreatic duct in all. Six patients were operated and tissue for pathological study was obtained in five, showing inflammatory infiltration. Vive patients were treated with steroids with a good clinical response. Conclusions: Autoimmune pancreatitis must be borne in mind in the differential diagnosis of pancreatic lesions.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Autoimmune Diseases , Pancreatitis , Autoimmune Diseases/diagnosis , Autoimmune Diseases/pathology , Autoimmune Diseases/therapy , Cholangiopancreatography, Endoscopic Retrograde , Magnetic Resonance Imaging , Pancreatitis/diagnosis , Pancreatitis/pathology , Pancreatitis/therapy , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Se presenta un caso clínico de nefroblastoma quístico parcialmente diferenciado (NQPD), estableciéndose que a pesar de los avances tecnológicos en los métodos no invasivos de diagnóstico, sólo el estudio histopatolófico permite la diferenciación con otras lesiones renales quísticas, especialmente con el nefroma quístico o quiste renal multiloculado. La nefrectomía simple es la indicación más adecuada para el diagnóstico y tratamiento del NQPD. La clasificación de esta lesión como una variedad del tumor de Wilms, obliga a un seguimiento y control estricto de estos pacientes