Application of enhanced recovery after surgery in abdominal tumor surgery / 中国肿瘤临床

Enhanced recovery after surgery (ERAS) represents a transformation to the evidence-based medicine paradigm in perioperative treatment. ERAS aims to reduce recovery time, postoperative complications, and healthcare costs. Here, we review the development and principal components of ERAS along with its application in abdominal tumor surgery. The benefits and feasibility of the ERAS protocol have been demonstrated in clinical practice, particularly in relation to colorectal surgery.

Tumor de células germinales mixto de ovario y una inusual combinación / Mixed ovarian germ cell tumor, an unusual combination

Resumen ANTECEDENTES: Los tumores de células germinales del ovario son poco frecuentes. Desde el punto de vista clínico y biológico son heterogéneos. Están formados por varios tipos de tumores histopatológicamente diferentes, que derivan de células primitivas y que se anidan de forma ectópica, proliferan y sufren transformación maligna. CASO CLÍNICO: Paciente de 10 años llevada a la consulta debido a la pérdida de peso en un periodo corto, dolor abdominal y aumento del perímetro abdominal. En la exploración se encontró una tumoración abdominopélvica de 20 x 20 cm, fija, pétrea, con un ganglio cervical izquierdo palpable. Los marcadores tumorales reportaron: alfafetoproteína 1104 ng/mL, B-HCG 865.6 mUi/mL. La TAC mostró una lesión que ocupaba el abdomen y la pelvis con densidad heterogénea de 14 x 12 x 10 cm. Se intervino para extirpación del tumor y enseguida se le indicó un esquema de quimiterapia. El reporte de patología reportó ser una tumoración germinal mixta con 5 tipos histológicos, muy agresiva, que terminó con la vida de la paciente 9 meses después. CONCLUSIÓN: Los tumores malignos de las células germinales son extremadamente malignos y de crecimiento rápido, con un pico de incidencia en niñas, adolescentes y mujeres jóvenes. Los síntomas se relacionan con el crecimiento rápido que se caracteriza por dolor pélvico-abdominal relacionado con la distensión capsular, hemorragia o necrosis. La estadificación quirúrgica es el primer paso en el tratamiento del cáncer de células germinales de ovario. La tasa de supervivencia es mayor de 95% en etapa temprana (l-ll), 80% en etapa lll y 60% en etapa lV, por lo que el diagnóstico y tratamiento oportuno son lo más importante.

Abstract BACKGROUND: Ovarian germ cell tumors are rare, clinically and biologically heterogeneous tumors, formed by several types of histopathologically different tumors that derive from primitive cells and that are nested ectopically, proliferate and undergo malignant transformation. CLINICAL CASE: A 10-year-old patient who came to consult for weight loss and abdominal pain as well as an increase in abdominal perimeter of rapid growth. A fixed abdominal tumor of 20 x 20 cm is scanned and found, as well as palpable left cervical lymph node. Tumor markers showing alphafetoprotein were taken. 1104 ng/mL, B-HCG 865.6 mUi/mL. The CT scan showed a lesion that occupies abdomen and pelvis with a heterogeneous density of 14 x 12 x 10 cm. It was decided to intervene surgically and complement with chemotherapy; The pathology report reported being a mixed germ tumor with 5 very aggressive histological types that ended with the patient´s life 9 months later. CONCLUSION: Malignant germ cell tumors are extremely malignant and rapidly growing, with a peak incidence in girls, adolescents and young women. Symptoms are related to rapid growth characterized by pelvic-abdominal pain related to capsular distention, hemorrhage or necrosis. Surgical staging is the first step in the treatment of ovarian germ cell cancer. The survival rate is greater than 95% in early stage (l-ll), 80% in stage lll and 60% in stage lV, so the diagnosis and timely treatment is the most important.

Clinical value of multi-slice spiral CT angiography in the diagnosis of abdominal tumors / 中国基层医药

Objective To study the clinical value of multi－slice spiral CT angiography in the diagnosis of abdominal tumors. Methods From January 2015 to December 2017,90 patients with abdominal neoplasms in the First People＇s Hospital of Yongkang were divided into two groups according to double－blind randomized method,with 45 patients in each group. The patients with conventional CT scan were included in the control group,and the patients with multislice spiral CT angiography were selected as the observation group. The scan results,invasion range and location of abdominal tumor, vascular display and perfusion parameters were compared between the two groups. Results The diagnostic accuracy of abdominal tumor and invasion range in the observation group ( 93. 33% , 80. 00% ) was higher than those of the control group(χ2=5. 414,5. 086,all P＜0. 05). The proportions of abnormal thickening of one supply artery(27 cases) and two blood supply arteries(8 cases) in patients with malignant and borderline venereal lesions with normal diameter were higher than those of patients with benign lesions(χ2=31. 765, 8. 372,all P＜0. 05). The contrast medium through time,blood flow,blood volume and capillary surface permeability in patients with benign lesions and normal average diameter were (10. 55 ± 3. 02) s,(21. 54 ± 5. 58) mL·min－1· 100 g－1,(4.04 ±0.76) mL/100 g,(10.16 ±2.73)mL·min－1·100 g－1,respectively,which were lower than those of patients with malignant and border venereal focal lesions (t =3. 016,5. 005,4. 982,6. 989,all P ＜0. 05). Conclusion Application of multislice spiral CT angiography in the clinical diagnosis of abdominal tumors has high accuracy and can better display the abnormal condition of blood vessels.

Clinical Features of Von-Hippel-Lindau Syndrome and Its Ultrasonographic Diagnosis of Abdominal Mass / 中国医学科学院学报

Objective To analyze the clinical features of Von-Hippel-Lindau(VHL)syndrome and explore the diagnostic value of abdominal ultrasound for this disease.Methods The clinical features including age at first diagnosis,symptoms,signs,affected organs,number of operations,and diagnostic examinations of 35 patients with VHL syndrome admitted to our center from January 1994 to December 2017 were retrospectively analyzed.The diagnostic value of abdominal ultrasound for VHL syndrome was analyzed.Results Pheochromocytoma(=14)and nervous system hemangioblastoma(=13)were the common firstly-identified tumors.Nervous system hemangioblastoma(=21),pheochromocytoma(=19),renal carcinoma(=17),and pancreatic mass(=15)were common tumors.The main surgical reasons were nervous system hemangioblastoma(=22),pheochromocytoma(=23)and renal carcinoma(=13).Abdominal organ involvements were found in 33 patients,which were first detected by abdominal ultrasound in 20 patients and were found accidently during routine health checkups in 6 patients.The ultrasound results were accurate in 27 of 33 adrenal gland scans,13 of 16 pancreas scans,and 8 of 19 kidney scans.Conclusions When multiple tumors are detected in the kidney,adrenal gland,and pancreas by ultrasound,the possibility of VHL syndrome should be considered.When the clinical findings suggest the possibility of VHL syndrome,ultrasound can discover and diagnose the abdominal tumors and can also be used for the long-term follow-up of the tumors.Therefore,ultrasound is an important method in the screening and follow-up of patients with VHL syndrome.

Hiperplasia prostática gigante. Adenocarcinoma. Reporte de un caso / Giant prostatic hyperplasia. Adenocarcinoma. Case report

RESUMEN Se presenta el caso de una hiperplasia prostática gigante, combinada con un adenocarcinoma que se presentó como una tumoración abdominal. El paciente presentaba una tumoración palpable en hipogastrio y un síndrome obstructivo urinario bajo. Se intervino quirúrgicamente y se realizó adenomectomía combinada, transvesical y retropúbica. La biopsia informó pequeño adenocarcinoma prostático acinar Gleason 3-4 puntos, en el contexto de una hiperplasia prostática. El paciente evolucionó satisfactoriamente y se sigue en consulta. La tumoración extraída tenía 736 g y constituye la de mayor peso reportada en Cuba y la quinta a nivel mundial (AU).

ABSTRACT We describe the case of a giant prostatic hyperplasia, combined with an adenocarcinoma presented as an abdominal tumor. The patient had a palpable tumor in the hypogastrium and a low urinary obstructive syndrome. He was operated and a combined, transvesicular and retropubic adenomectomy was performed. The biopsy informed a little 3-4 points-Gleason, acinar, prostatic adenocarcinoma, in the context of a prostatic hyperplasia. The patient evolved satisfactorily and was followed up in consultation. The removed tumor was 736 g, and is the heaviest one reported in Cuba and the fifth worldwide (AU).

Ultrasound-guided transversus abdominis plane block for intraoperative and postoper-ative analgesia of abdominal tumor patients treated with minimally invasive surgery / 中国肿瘤临床

Objective:To investigate the effect of ultrasound-guided transversus abdominis plane block on intraoperative and postoper-ative analgesia in laparoscopic abdominal surgery.Methods:Sixty ASAⅠ-Ⅱpatients with abdominal tumor,undergoing laparoscopic/robotic surgery were randomly assigned into two groups:one group undergoing general anesthesia(G group)and the other undergo-ing general anesthesia combined with transversus abdominis plane block(G+T group).After induction of general anesthesia in the G+T group,the patients received transversus abdominis plane block with injection of 15 Ml of 0.25% ropivacaine on each side,guided by ultrasound.The operation time,resuscitation time,orientation recovery time,and the dosage of remifentanyl were recorded and com-pared.During surgery,the MAP and HR at different time points(5 min before,after surgical incision;30 min after the surgery begin-ning;surgery finished)between the two groups were recorded and compared.Additionally,the VAS scores at different postoperative time points were compared between the two groups.Results:Compared to the G group,the resuscitation time,orientation recovery time and the dosage of remifentanyl in the G+T group were significantly decreased(P<0.05).In G group,compared to the basic value, the MAP and HR at 5 min and 30 min after surgical incision were significantly increased(P<0.05);whereas in the G+T group,the MAP and HR remained stable at different time points(P>0.05).Moreover,compared to the G group,the VAS score in the G+T group was sig-nificantly lower at 2,6,and 12 hours postoperatively(P<0.05).Conclusions:General anesthesia combined with transversus abdominis plane block in patients undergoing laparoscopic abdominal surgery reduces the intraoperative and postoperative remifentanil con-sumption,improves the efficacy of perioperative analgesia,and enhances the patient's recovery after surgery.

A study on prediction algorithm for respiratory movement in the radiotherapy of thoracic and abdominal tumor / 中国医学装备

Due to the influence of respiratory movement in thoracic and abdominal radiotherapy, the real-time tracking technique was effective solution in the contemporarily precise radiotherapy. This article summarized prediction algorithm of several respiratory movement that was used to compensate the delay caused by system response in the real-time tracking radiotherapy, and compared the characteristics, performance and developing situation of various algorithm, and prospected the development and tendency of real-time tracking technique in future.

Study on effectiveness of radiotherapy line image guidance for dose-error correction in patients with abdominal tumor / 医疗卫生装备

Objective To investigate the effect of the correction of the position error of the abdominal tumor by cone beam scanning. Methods Six patients with abdominal tumor were selected with double-blind method, and electronical portal imaing device was used to collect the information of the patient dosimetry during radiotherapy.EDOSE tool was applied to 3D dose reconstruction so as to execute real-time 3D dose verification of the treatment plan. Each patient had 5 sets of data acquired when image guidance existed and another 5 sets when image guidance was absent. The treatment effects with or without image guidance were compared.Results The overall γ passing rate with cone beam CT image guidance gained no advantages over that without image guidance, though the setup error was corrected to some extent. Image guidance contributed nothing to increasing target area coverage while decreasing exposure dose to normal tissue. Conclusion Setup error correction by the image guidance based on bone marker has no significant effect on improving 3D dose verification and dose accuracy during the radiotherapy of the abdominal tumor patient.

Clinical study of abdominl type of tumor cells to destroy the loss after neoadjuvant chemotherapy in treatment of epithelial ovarian cancer stage Ⅲ C / 中国综合临床

Objective To investigate the effect of abdominl type of tumor cells to destroy the loss after neoadjuvant chemotherapy in treatment of epithelial ovarian cancer stage Ⅲ C.Methods Eighty cases patients of stage ⅢC epithelial ovarian cancer who were treated in Traditional Chinese Medicine Hospital of Meizhou from June 2010 to June 2012 were enrolled in this study and all were consistent with the diagnostic criteria and no operation contraindications.They were randomly divided into two groups with 40 cases in each group according to the paired grouping method.The observation group was treated with abdominal type intermediate tumor cell reduction surgery after neoadjuvant chemotherapy,and the control group was treated with abdominal intermediate tumor cells.Two groups were treated by paclitaxel and carboplatin chemotherapy after the operation,the curative effect between the two groups was compared.Results Blood loss during operation of patients in observation group were lower than control group,the difference was significant((512.6±98.6) ml vs.(785.6±91.2) rnl,P＜0.001).The operation time of patients in observation group was shorter than that of control group,the difference was significant((215.6±42.6) min vs.(285.6±43.9) min,P＜0.01).The ascites of patients in observation group were less than that of control group,the difference was significant((689.5±215.6) ml vs.(1 265.9±325.6) ml,P＜0.01).There was no significant difference in the length of stay between the two groups (P＞0.05).There were 11 cases(27.5％) of complete remission,24 cases(60.0％) of partial remission,4 cases of stable (10％,4/40),1 case (2.5％,1/40) of progress in the observation group recently;while in control group,complete remission in 5 cases(12.5％),partial remission in 9 cases (22.5％),stable in 20 cases(50％,20/40),progress in 6 cases (15.0％,6/40),the differences between the two groups were statistical significance (P＜0.001).The 3 year survival rate of observation group was significantly higher than that of control group (92.5％ vs.72.5％,P =0.0394).Conclusion The effect of abdominl type of tumor cells to destroy the loss after neoadjuvant chemotherapy in treatment of epithelial ovarian cancer stage ⅢC is better,it has the important clinical value.

An unusual abdominal wall mass in a child

ABSTRACT Abdominal tumors are one of the most common types of pediatric cancer. Therefore, they should always be included in the differential diagnosis of abdominal masses. Here, we present the case of a child whose initial hypothesis of diagnosis contemplated this possibility. Later, it was demonstrated that the abdominal mass found was secondary to a common parasitosis. A 2-year old, moderately malnourished and pale white boy was referred with a history of a rapidly growing, well-limited, middle abdominal mass. The mass was 10 by 3 cm, hard and poorly movable, apparently involving both abdominal rectus muscles. A complete resection was performed, revealing an abdominal wall abscess, with intense eosinophilic proliferation, secondary to a local and intense reaction to innumerous Ascaris lumbricoides eggs. Extra luminal infestations with Ascaris, that usually form peritoneal granulomas have been previously described. However, neither external trauma nor fistula, that could explain the superficial presence of the eggs, was found. This description reinforces the relevance of infectious diseases within the differential diagnosis of abdominal masses, particularly in areas with high prevalence of parasitic infestations.

Incidental Mesenteric Paraganglioma: A Case Report and Literature Review

Mesenteric paragangliomas are a rare entity; consequently, only 12 cases have been reported to date. Although considered benign and often found incidentally, they have the potential to metastasize and are an important diagnosis to consider for patients with a mesenteric tumor. We report the case of a 71-year-old woman who was found on magnetic resonance imaging to have an incidental, large, complex, intra-abdominal mass that had initially been misdiagnosed as ovarian in origin. She underwent an open resection of the tumor and adjacent small bowel with no perioperative complications; histology confirmed the mass to be a mesenteric paraganglioma. This case report highlights several important key issues regarding paraganglioma, including diagnosis, imaging, genetic testing, and surgical resection. The results of a literature review are also discussed.

Clinical Observation of Hypoxia Flow Sevoflurane Combined with Propofol for Elderly Abdominal Tumor Surgery in Saturation / 中国药房

OBJECTIVE:To observe the anesthesia effect and safety of hypoxia flow sevoflurane combined with propofol for el-derly abdominal tumor surgery in saturation. METHODS:128 elderly patients took abdominal tumor surgery under general anesthe-sia were randomly divided into observation group(64 cases)and control group(64 cases). After routine anesthetic induction,the oxygen flow was adjusted to 6 L/min,vaporizer was adjusted to 2%,10 minutes after inhalation,the observation group was adjust-ed to 0.5 L/min,and control group was 1.5 L/min,all received 0.5 mg/L propofol by target-controlled infusion,continuous infu-sion of remifentanil,intermittent bolus injection of vecuronium 1-2 mg/times based on the intraoperative muscle relaxation. Heart rate(HR),mean arterial pressure(MAP),oxygen saturation(SpO2),central venous pressure(CVP),inspired oxygen concentra-tion(FiO2),end-tidal carbon dioxide partial pressure [p(CO2)] in 10 min(T0),intraoperative 1 h(T1),intraoperative 2 h(T2), end of surgery(T3)in 2 groups were observed;sevoflurane dosage,recovery time,restlessness,and blood urea nitrogen(BUN), serum creatinine (Cr),alanine aminotransferase (ALT) levels,incidence of early cognitive dysfunction before and after surgery and the incidence of adverse reactions in 2 groups were recorded. RESULTS:There were no significant differences in the HR, MAP,SpO2,CVP,FiO2 and p(CO2)in 2 groups at different time points(P>0.05). The sevoflurane dosage,recovery time,the incidences of cognitive dysfunction postoperative 3 h and 6 h and adverse reactions in observation group were significantly lower than control group,the differences were statistically significant (P0.05). After surgery,ALT levels in 2 groups were significantly higher than before,the difference was statistically significant(P0.05). There were no significant differences in preoperative ALT and preoperative and postoperative BUN and Cr between 2 groups(P>0.05). CONCLUSIONS:Hypoxia flow sevoflurane combined with propofol shows obvious anesthe-sia effect for elderly abdominal tumor surgery in saturation,with stable hemodynamics,it can reduce sevoflurane dosage,shorten the recovery time and reduce the incidence of early postoperative cognitive dysfunction,with good safety.

Carcinoma de corteza suprarrenal simulando un carcinoma renal. Reporte de caso / Carcinoma of suprarenal bark simulating a renal carcinoma. Report of a case

Fundamento: El carcinoma de corteza suprarrenal es inusual su presentación, y menos con las características del caso que se presenta; además de no ser tenido en mente por la mayoría de los clínicos. Objetivo: Exponer un caso de carcinoma de corteza suprarrenal el cual clínicamente simulaba un carcinoma renal con un síndrome metastásico múltiple. Presentación de caso: Paciente de 63 años, diabético tipo I e hipertenso que se ingresó por dolor abdominal en epigastrio y mesogastrio acompañado de vómitos, diarreas, sensación de plenitud gástrica y pérdida de 10 kg de peso en los últimos meses. Tres días antes de su ingreso se constató diarreas abundantes, prurito, fiebre, hematuria múltiple, coluria, acolia e íctero. Al examen físico se observó mucosas deshidratadas y pálidas, íctero, deshidratación y pérdida de 10 kg de peso. Aparato respiratorio: Murmullo vesicular disminuido globalmente, estertores crepitantes aislados en ambos campos pulmonares. Aparato digestivo: hepatomegalia de 6 cm irregular y tumoración en flanco izquierdo de 10-12 cm con contacto lumbar. El estudio analítico mostró anemia, enzimas hepáticas elevadas, hematuria, velocidad de sedimentación globular, lactato deshidrogenasa y fosfatasa alcalina elevadas, con estudio imaginológico que señalaba un proceso metastásico en hígado, pulmón y ganglios con un posible origen renal. El paciente falleció a las 48 horas; se encontró un carcinoma de corteza suprarrenal en la necropsia y se confirmó en el estudio histopatológico. Conclusiones: Se presentó un paciente con carcinoma de corteza suprarrenal que simuló un carcinoma renal con manifestaciones clínicas sugestivas de proceso tumoral renal. El carcinoma de corteza suprarrenal es un tumor muy raro que puede evolucionar de forma asintomática, dando manifestaciones clínicas cuando adquiere gran tamaño o es hiperfuncionante. Frente a una tumoración de localización retroperitoneal o de clínica no característica, el clínico debe tener en cuenta esta enfermedad.

Background: The suprarenal cortex carcinoma has an unusual presentation and much less with the characteristics presented in this case, besides not being in the mind of the great majority of clinicians. Objective: To show a case of carcinoma of suprarenal cortex this clinically simulated a renal carcinoma with a multiple metastatic syndrome. Case presentation: A 63 year old diabetic type I and hypertensive patient, who was admitted due to abdominal pain in epigastrium and mesogaster accompanied by vomits, diarrheas, sensation of gastric fullness and loss of 10 kg of weight in the last months. Three days before his admission, it was found that he had had several episodes of diarrheas, pruritus, fever, multiple hematuria, choluria, acholia and jaundice. On physical examination it was observed that he had dehydrated mucous and paleness. Respiratory system: vesicular murmur diminished globally, isolated crepitants rale in both lung fields. Digestive system: hepatomegaly of 6 cm irregular and a tumor in left flank of 10-12 cm with lumbar contact. The analytic study showed anemia, elevated hepatic enzymes, hematuria, and rapid globular sedimentation, dehydrogenase lactate and elevated alkaline phosphatase, with imaging study which showed a metastatic process in liver, lung and ganglion with a possible renal origin. The patient died 48 hours after admission, on autopsy it was found that there was a carcinoma of suprarenal cortex which simulated a renal tumor confirmed in the histopathological study. Conclusiones: A patient with a suprarenal cortex carcinoma was admitted to a hospital simulating a renal carcinoma with clinical manifestations suggesting a renal tumoral process. This type of carcinoma is very weird and may evolve asymptomatically, showing clinical characteristics when they have a big size or it is hyperfunctioning. When facing a tumor like this of retroperitoneal location or non characteristic clinic, the doctor must bear in mind this disease.

Hemangioma cavernoso del mesosigmoide: informe de un caso y revisión de la bibliografía / Cavernous hemangioma of the mesosigmoid: a case report and literature review

Se informa un caso de hemangioma cavernoso del mesosigmoide, su presentación clínica, diagnóstico y tratamiento, y se ofrece una revisión de la literatura asequible sobre el tema, para lo cual se realizó una búsqueda en las bases de datos de Medigraphic, Cochrane, Medline y PubMed. El paciente es un hombre de 72 años de edad, que se presentó con dolor abdominal, estreñimiento, pérdida de peso y masa tumoral en la fosa ilíaca izquierda. A pesar de las investigaciones imaginológicas y endoscópica, no se pudo hacer el diagnóstico preoperatorio. Se trató por laparotomía y resección del tumor, y el diagnóstico se confirmó por estudio histopatológico. El hemangioma cavernoso del mesosigmoide es un tumor raro, difícil de diagnosticar preoperatoriamente, a pesar de las avanzadas técnicas imaginológicas. La escisión quirúrgica y el examen histológico pueden ser los únicos medios para el diagnóstico.

This article reported a case of cavernous hemangioma of the mesosigmoid, its clinical presentation, diagnosis and treatment. It also offered literature review on this topic for which search into the Medigraphic, Cochrane, Medline and Pubmed databases was made. The patient was a 72 years-old man that went to the hospital with abdominal pain, constipation, loss of weight and tumor mass in the left iliac cavity. Despite imaging and endoscopic research, it was not possible to reach diagnosis preoperatively. He underwent laparotomy and tumor resection and the final diagnosis was confirmed in the histopathological study. The cavernous hemangioma of the mesosigmoid is a rare tumor difficult to preoperatively diagnose despite the advanced imaging techniques. Surgical excision and histological exam are the only means to reach diagnosis.

Embarazo abdominal calcificado con 44 años de evolución / Calcified abdominal pregnancy with 44 years of evolution

Lithopedion (litho = piedra, pedion = niño), es el término utilizado para describir un feto intrabdominal calcificado. Es un evento raro, con aproximadamente 300 casos descritos en la literatura internacional. Este artículo trata del caso de una mujer de 84 años con dolor abdominal, donde se evidenció en el examen físico, una masa abdominal de consistencia pétrea, con dimensiones de 23 cm de altura y 32 cm de longitud. El examen radiológico del abdomen reveló la presencia de imagen de densidad ósea, sugiriendo la existencia de un feto abdominal calcificado. La tomografía computarizada confirmó tratarse de un litoquelifopedion de 29-30 semanas, con aproximadamente 44 años de evolución.

Lithopedion (litho = stone, pedion = child) is the term used to describe an intra-abdominal calcified fetus. In the international literature, about 300 cases were described. In this case, an 84-year old woman was admitted with abdominal pain and the abdominal physical examination showed a mass with hard consistency with 23 cm height and 32 cm width. The abdominal x-ray examination showed the presence of bone density image suggesting an intra-abdominal calcified fetus. The computer tomography confirmed that it was a litoquelifopedion of 29-30 weeks of pregnancy and with about 44 years of evolution.

Pielonefritis xantogranulomatosa en pediatría / Xantoranulomatous pyelonephritis in children

Se presenta el caso clínico de un pre-escolar masculino de 2 años de edad, con antecedentes de infección urinaria a repetición y fiebre no cuantificada de varios días de evolución. Ingresa con temperatura de 38,5°C, aumento de volumen en región lumbar izquierda de 4 cms de diámetro, blanda, no dolorosa, bordes no bien definidos, Se practican exámenes complementarios concluyendo de que se trata de patología tumoral renal izquierda. Se realizó laparotomía, donde se evidencio riñón izquierdo con cápsula lisa, adherida a la superficie pequeños nódulos amarillentos, indurados en toda su extensión a predominio del borde externo; se practicó nefrectomía izquierda. Presento postoperatorio sin complicaciones, egresando en buenas condiciones generales con diagnóstico anatomopatológico de Pielonefritis Xantogranulomatosa.

We report the case of a 2 years old male infant, with a history of recurrent urinary tract infection and high temperature during several days. On admission he had a temperature of 38.5 ° C and a soft, non-tender, well-defined 4 cm mass in the left lumbar region. Preoperative tests suggested the presence of a left renal tumor for which a laparotomy was performed with the following finding; left kidney with a smooth capsule with small yellow hard nodules adhered to its surface along the extension of the outer edge. A left nephrectomy was performed. He had an uneventful postoperative period and was discharged in good general condition. The pathological study reported a Xanthogranulomatous Pylonephritis.

Tumores abdominais malignos mais frequentes na infância: diagnóstico diferencial / Most common abdominal malignancies in childhood: differential diagnosis

Objetivo: Discutir as características clínicas e laboratoriais dos tumores malignos abdominais mais frequentes na infância, contribuindo para o diagnóstico precoce destas doenças. A maioria das massas abdominais é causada por doenças benignas. Eventualmente, neoplasias malignas da infância também se manifestam como tumor abdominal. Os autores discutem as principais características dos tumores abdominais malignos mais frequentes na infância. Conclusão: Através da análise dos dados clínicos e do exame físico do paciente com tumor abdominal, o pediatra pode traçar hipóteses diagnósticas e encaminhar precocemente a criança para centros especializados...

Sarcoma de vena cava inferior / Sarcoma of the vena cava inferior

Se presentó un caso infrecuente de una paciente con tumor abdominal y gran circulación colateral superficial tipo cava-cava, el ultrasonido abdominal, el ecocardiograma trans-torácico y transesofágico y la tomografía axial computarizada identificaron un tumor de la vena cava inferior. La citología aspirativa con aguja fina de la lesión confirmó que se trataba de un sarcoma fusopleomórfico de alto grado de malignidad primario de la vena cava inferior

Authors present an infrequent case of a female patient with abdominal tumor a great superficial collateral circulation type cava-cava, the abdominal ultrasound, the transthoracic and transesophageal echocardiogram and the computerized axial tomography (CAT) identified a tumor of the vena cava inferior. The fine-needle aspiration cytology of lesion confirmed the presence of primary fusopleomorphous sarcoma of high degree of malignancy of vena cava inferior

Carcinoma suprarrenal gigante / Giant suprarenal carcinoma

OBJETIVO: presentar un caso de carcinoma suprarrenal de gran tamaño, su diagnóstico y tratamiento. DESCRIPSIÓN: se presenta un paciente del sexo masculino, de 69 años de edad, con antecedentes de diabetes mellitus tipo II que refería palparse un tumor abdominal. Al examen físico tenía un tumor palpable en la fosa lumbar y flanco izquierdos de aproximadamente 15 a 16 cm de diámetro. El tumor se corroboró en el ultrasonido, por lo que fue necesario realizar la tomografía axial computadorizada simple y contrastada para establecer el origen suprarrenal de este. Se comprobaron niveles elevados de cortisol en plasma. INTERVENSIÓN: se realizó la suprarrenalectomía más la nefrectomía izquierdas. La evolución posoperatoria resultó satisfactoria. El informe histopatológico de la pieza quirúrgica fue carcinoma suprarrenal con infiltración renal. Se indicó tratamiento de quimioterapia con mitotano con posterioridad a la cirugía. En los controles semestral y anual realizados, el paciente se encontró asintomático y con niveles de cortisol sanguíneo normales. El ultrasonido, la tomografía axial computadorizada del abdomen y la radiografía del tórax no mostraron recidiva tumoral ni metástasis. CONCLUSIONES: los carcinomas suprarrenales pueden evolucionar de forma asintomática hasta alcanzar grandes dimensiones. El tratamiento combinado, quirúrgico y con quimioterapia, mejora el pronóstico de estos pacientes.

OBJECTIVE: this is the presentation of a case of a very large suprarenal carcinoma. DESCRIPTION: a male patient aged 69 with a history of type 2 diabetes mellitus mentioning the palpation of a abdominal tumor. At physical examination we noted the presence of a palpable tumor in lumbar fossa and left flanks of approximately 15 to 16 cm diameter. Ultrasound corroborated the tumor being necessary to perform a single and contrasted computed tomography to establish its suprarenal origin. There were high levels of cortisol in plasma. INTERVENTION: a left suprarenalectomy and nephrectomy were performed. Postoperative course was satisfactory. The histopathology report of the surgical specimen was a suprarenal carcinoma with renal infiltration. Chemotherapy with mitotane was prescribed after surgery. In half-yearly and yearly controls the patient was asymptomatic and with normal blood cortisol levels. Ultrasound, computerized axial tomography of abdomen and thorax X-rays not showed tumor relapse neither metastasis. CONCLUSIONS: suprarenal carcinomas may to evolve in an asymptomatic way and to have bid dimensions. Combined treatment of surgery and chemotherapy, improves the prognosis of these patients.

Sarcoma de Ewing extraesquelético que semeja abdomen agudo / Extra-skeletal Ewing's sarcoma resembling acute abdomen: case report

Introducción: El sarcoma de Ewing extraóseo es un tumor raro de origen neuroectodérmico que se ha presentado principalmente en las partes blandas de las extremidades y del tórax; histológicamente es similar al sarcoma de Ewing en el tejido óseo. Caso clínico: Paciente con abdomen agudo y leucocitosis, en quien por imagen (ultrasonido y tomografía axial computarizada) se diagnosticó enfermedad diverticular complicada del colon, por lo que fue intervenido quirúrgicamente, encontrando lesión localizada en el espacio de Retzius con extensión a la cavidad abdominal de 20 x 15 x 15 cm. El tratamiento consistió en extirpación del tumor, separándolo de las vísceras adyacentes y el paciente fue tratado con quimioterapia: epirrubicina, ciclofosfamida y vincristina por seis ciclos; la tomografía abdominal de control mostró actividad tumoral en el retroperitoneo, adyacente al colon ascendente y ciego, por lo que se requirió nuevo tratamiento resectivo. Conclusiones: En la revisión de la literatura no hay informes previos de sarcoma de Ewing extraóseo cuya presentación sea abdomen agudo. Por la rareza de esta lesión, en la literatura solo hay registro de casos o algunas series de casos, por lo que no fue posible llevar a cabo comparaciones; la extirpación de la lesión es el pilar del tratamiento. No se define el papel de la quimioterapia preoperatoria. La biopsia percutánea guiada por algún método de imagen es de utilidad para otorgar al paciente un tratamiento óptimo que le permita un mejor pronóstico.

BACKGROUND: Extraosseous Ewing's sarcoma is a rare tumor of neuroectodermal origin. It presents mainly in the soft tissue of the extremities and thorax. Histologically, it is similar to Ewing's sarcoma of the bone. CLINICAL CASE: We present the case of a male who arrived at the emergency room with acute abdomen, leucocytosis and imaging techniques (abdominal ultrasound and computed tomography) suggestive of complicated diverticular disease. He was treated with emergency surgery. Intraoperative findings were an unsuspected tumor (20 x 15 x 15 cm). Treatment consisted of extirpation of the tumor, separating it from the adjacent viscera and followed by chemotherapy based on epirubicin, cyclophosphamide and vincristine for six cycles. Because the control abdominal CT demonstrated tumor activity in the retroperitoneum adjacent to the ascending colon and cecum, further resection was decided upon. CONCLUSIONS: In a review of the literature, no previous reports of extraosseous Ewing's sarcoma were found presenting as acute abdomen. Due to the rarity of this tumor, only case reports or series have been found in the literature without randomized or comparative studies. Surgery was the cornerstone of treatment, without reports of preoperative chemotherapy. If the patient's condition permits, percutaneous needle biopsy is mandatory to obtain optimum treatment as well as to improve prognosis.