Neoplasia primaria sincrónica de estómago, colon y recto: reporte de un caso / Synchronous stomach, colon and rectum primary neoplasias: a case report

Presentamos el caso de un paciente masculino de 40 años de edad, con estreñimiento de un año de evolución y antecedentes de enfermedad por reflujo gastroesofágico, se realiza endoscopia digestiva alta y baja y se realiza diagnóstico sincrónico de adenocarcinoma de estómago, recto y colon descendente, realizamos tomografía por emisión de positrones con tomografía computarizada pre quirúrgico y cirugía como tratamiento primario. Mostramos una descripción del caso y una revisión de la bibliografía.

We present the case of a 40-year-old man with a one year evolution constipation and a history of GERD. An upper and lower digestive endoscopy was performed and a synchronous diagnosis of adenocarcinoma of the stomach, rectum and descending colon was established. A PET-CT pre-surgical was performed and the surgery was carried out as primary treatment. We show a description of the case and a bibliographic review.

Multiple skin neoplasms in subjects under 40 years of age in Goiania, Brazil / Neoplasias múltiplas de pele em indivíduos com menos de 40 anos em Goiânia, Brasil

OBJECTIVE To describe the trend for malignant skin neoplasms in subjects under 40 years of age in a region with high ultraviolet radiation indices.METHODS A descriptive epidemiological study on melanoma and nonmelanoma skin cancers that was conducted in Goiania, Midwest Brazil, with 1,688 people under 40 years of age, between 1988 and 2009. Cases were obtained fromRegistro de Câncer de Base Populacional de Goiânia(Goiania's Population-Based Cancer File). Frequency, trends, and incidence of cases with single and multiple lesions were analyzed; transplants and genetic skin diseases were found in cases with multiple lesions.RESULTS Over the period, 1,995 skin cancer cases were observed to found, of which 1,524 (90.3%) cases had single lesions and 164 (9.7%) had multiple lesions. Regarding single lesions, incidence on men was observed to have risen from 2.4 to 3.1/100,000 inhabitants; it differed significantly for women, shifting from 2.3 to 5.3/100,000 (Annual percentage change - [APC] 3.0%, p = 0.006). Regarding multiple lesions, incidence on men was observed to have risen from 0.30 to 0.98/100,000 inhabitants; for women, it rose from 0.43 to 1.16/100,000 (APC 8.6%, p = 0.003). Genetic skin diseases or transplants were found to have been correlated with 10.0% of cases with multiple lesions - an average of 5.1 lesions per patient. The average was 2.5 in cases without that correlation.CONCLUSIONS Skin cancer on women under 40 years of age has been observed to be increasing for both cases with single and multiple lesions. It is not unusual to find multiple tumors in young people - in most cases, they are not associated with genetic skin diseases or transplants. It is necessary to avoid excessive exposure to ultraviolet radiation from childhood.

OBJETIVO Descrever a tendência da incidência de neoplasias malignas de pele em indivíduos com menos de 40 anos de idade em região de altos índices de raios ultravioleta.MÉTODOS Estudo epidemiológico descritivo de câncer de pele melanoma e não melanoma realizado em Goiânia, Brasil, com 1.688 pessoas com menos de 40 anos de idade, no período de 1988 a 2009. Os casos incidentes foram obtidos do Registro de Câncer de Base Populacional de Goiânia. Foram analisadas: frequência, tendência e incidência de casos com lesões únicas e múltiplas e, nos casos de lesões múltiplas, a presença de transplante e de doenças genéticas cutâneas.RESULTADOS No período, ocorreram 1.995 casos de câncer de pele, dos quais 1.524 (90,3%) foram de lesão única e 164 (9,7%), lesões múltiplas. Das lesões únicas, a incidência em homens aumentou de 2,4 para 3,1/100.000 habitantes; em mulheres, diferiu significativamente, passando de 2,3 para 5,3/100.000 (Annual percentage change - [APC] 3,0%, p = 0,006). A incidência de lesões múltiplas em homens aumentou de 0,30 para 0,98/100.000 habitantes; nas mulheres, o aumento foi de 0,43 para 1,16/100.000 (APC 8,6%, p = 0,003). Encontrou-se associação com doença genética cutânea ou transplante em 10,0% dos casos com lesões múltiplas, com média de 5,1 lesões por paciente. Nos casos sem associação essa média foi de 2,5.CONCLUSÕES A incidência de câncer de pele em mulheres com menos de 40 anos está aumentando tanto com lesões únicas, quanto com múltiplas. A ocorrência de tumores múltiplos em jovens não é raro e na maioria dos casos não está associado à doença genética cutânea ou transplante. É necessário prevenir a exposição excessiva à radiação ultravioleta desde a infância.

Synchronous primary cancers of the head and neck region and upper aero digestive tract: Defining high-risk patients

Background: Patients with cancers in the head and region are at increased risk of developing synchronous primary cancers. Aim: To see the epidemiology of synchronous cancers of the head and region and identification of high-risk factors for the development of synchronous primary in the head and neck cancers. Materials and Methods: Data of head and neck cancer patients from January 2010 to December 2011 were obtained from the hospital cancer registry for retrospective analysis of patients with synchronous cancers. All synchronous malignancies were analyzed for distribution of sites, association with smoking history, stage of index head, and neck tumor and the average age of patients at presentation with synchronous cancers. The Chi-square test for association of upper aero digestive tract (UADT) and smoking and statistical formula of median for calculating the average age have been employed for analysis. Results: Incidence of synchronous primaries has been found to be 1.33%, majority were seen at the oropharynx (39.2%) and 60.7% synchronous occurred at the esophagus, 0.81% of all head and neck cancers developed synchronous primary at the esophagus. Approximately, 65% of all synchronous primaries were in Stage III and Stage IV disease and 88.2% esophageal synchronous had Stage II disease. Association of UADT synchronous cancers with smoking is highly significant, relative risk = 1.95 95% confidence interval for relative risk 1.05-3.64 P = 0.00010981 (P < 0.05) and the average age is 62.4 years in males and 57.8 years in females. Conclusion: Patients who are at the high-risk for the development of synchronous primary tumors in the cancers of the head and neck region are patients with oropharyngeal carcinoma, smoking population, patients over the age of 62 years in males, and 57 years in females and in patients with higher staged index tumor.

Incidence and epidemiological features of synchronous and metachronous colorectal cancer / Incidencia e perfil epidemiologico do cancer colorretal sincronico e metacronico

INTRODUCTION: patients with sporadic colorectal cancer or cases associated with syndromes are at risk of having synchronous or metachronous cancer. Although it is an important subject, Brazilian data on the subject are scarce. OBJECTIVE: to evaluate the incidence and epidemiological features in patients with synchronous and metachronous colorectal cancer in a reference service of proctology in the Rio Grande do Sul. Methods: cross-sectional observational study, performed between January and July 2012, analyzing all patients admitted in the service that met the inclusion criteria. A retrospective review of records was performed, noting demographic variables, comorbidities and tumor-related variables. RESULTS: 150 records were analyzed, of which 53.3% were males and mean age was 63 (± 13.01) years old. The most frequently found tumor location was the sigmoid colon and high rectum (50.67%), followed by the lower rectum (36%). Adenocarcinomas were the most prevalent histological subtype (88%), followed by epidermoid tumors (1.33%). Hereditary syndromes were identified in five patients (3.33%), with four being Familial adenomatous polyposis (FAP) and one hereditary nonpolyposis colorectal cancer (HNPCC). Among the analyzed patients, four (2.67%) had synchronous and one (0.67%) had metachronous cancer. CONCLUSION: the incidence of synchronous and metachronous colorectal cancer was, respectively, 2.67% and 0.67%, results that corroborate those reported in international literature. (AU)

INTRODUÇÃO: pacientes com diagnóstico de câncer colorretal esporádico ou associado a síndromes correm risco de apresentar lesões sincrônicas ou metacrônicas. Embora seja relevante, há escassez de informações sobre o tema na literatura nacional. OBJETIVO: avaliar a incidência e o perfil epidemiológico dos pacientes com tumor colorretal sincrônico e metacrônico em um serviço de referência em proctologia do Rio Grande do Sul. MÉTODO: estudo observacional transversal, realizado entre janeiro e julho de 2012, avaliando-se pacientes atendidos no serviço que preencheram os critérios de inclusão. Revisaram-se os prontuários, registrando-se variáveis demográficas, comorbidades e variáveis relacionadas ao tumor. RESULTADOS: analisaram-se 150 prontuários, sendo 53,3% do sexo masculino com média de idade de 63 (+13,01) anos. A topografia mais incidente foi cólon sigmoide e reto alto (50,67%) seguido do reto baixo (36%). O adenocarcinoma foi o subtipo histológico mais prevalente (88%) seguido pelo epidermoide (1,33%). Síndromes hereditárias foram identificadas em cinco pacientes (3,33%), sendo quatro com polipose adenomatosa familiar e um paciente com câncer colorretal hereditário não polipose. Dos 150 pacientes, quatro (2,67%) apresentaram neoplasia sincrônica e um (0,67%) lesão metacrônica. Conclusão: a incidência de tumor colorretal sincrônico e metacrônico na população avaliada foi, respectivamente, 2,67% e 0,67%, resultados que corroboram achados da literatura estrangeira. (AU)

Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) has become accepted as a minimally invasive treatment for gastric neoplasms. However, the development of synchronous or metachronous gastric lesions after endoscopic resection has become a major problem. We investigated the characteristics of multiple gastric neoplasms in patients with early gastric cancer (EGC) or gastric adenoma after ESD. METHODS: In total, 512 patients with EGC or gastric adenoma who had undergone ESD between January 2008 and December 2011 participated in this study. The incidence of and factors associated with synchronous and metachronous gastric tumors were investigated in this retrospective study. RESULTS: In total, 66 patients (12.9%) had synchronous lesions, and 13 patients (2.5%) had metachronous lesions. Older (> 65 years) subjects had an increased risk of multiple gastric neoplasms (p = 0.012). About two-thirds of the multiple lesions were similar in macroscopic and histological type to the primary lesions. The median interval from the initial lesions to the diagnosis of metachronous lesions was 31 months. The annual incidence rate of metachronous lesions was approximately 3%. CONCLUSIONS: We recommend careful follow-up in patients of advanced age (> 65 years) after initial ESD because multiple lesions could be detected in the remnant stomach. Annual surveillance might aid in the detection of metachronous lesions. Large-scale, multicenter, and longer prospective studies of appropriate surveillance programs are needed.

Predisposición genética para el cáncer de mama: genes BRCA1 y BRCA2 / Genetic predisposition for breast cancer: BRCA1 and BRCA2 genes

El descubrimiento de los genes BRCA1 y BRCA2 ha llevado a la introducción de pruebas genéticas cada vez más sofisticadas para medir el riesgo de cáncer de mama de origen hereditario, entre otras cosas. En el presente artículo exploramos los criterios a seguir para realizar pruebas para estos genes, así como las implicaciones en el tratamiento para los pacientes en caso de identificarlos.

The discovery of genes BRCA1 and BRCA2 has led to the introduction of genetic tests more complex every time for the evaluation ofthehereditarycancerrisk,amongothers.In the present paper we explore the criteria to decide when to run the testing for the genes, as well as the implications for the treatment of patients who are identified with them.

Presentación sincrónica de cáncer colorrectal y tumor renal / Simultaneous presentation of renal cell and colorectal cancer

Introducción: La presencia simultánea de dos cánceres primarios en el organismo es un evento de baja frecuencia. La presentación sincrónica de cáncer colorectal y renal es un ejemplo de esto, con una prevalencia entre el 0,33-0,5 por ciento de tumores renales en pacientes portadores de cáncer colorrectal. Objetivos: Determinar la frecuencia de presentación simultánea de cáncer colorectal y tumor renal en nuestro medio, y analizar el manejo de esta doble patología desde el punto de vista quirúrgico. Material y método: Se registró el total de pacientes con diagnóstico de cáncer colorectal y tumor renal en el Hospital Clínico Universidad de Chile durante el período comprendido entre el 1o de enero de 1990 al 1o de julio de 2006. Se incluyó en el estudio sólo aquellos pacientes que presentaban ambos tumores sincrónicamente. Resultados: Los pacientes con diagnóstico de tumor renal corresponden a 303 casos, mientras que 623 casos presentaron el diagnóstico de cáncer colorectal. La presencia simultánea de cáncer colorectal y tumor renal fue encontrada en 6 casos (hombres =5; mujeres =1). Esto representa una prevalencia de 0,86 por ciento de presentación simultánea de tumor renal en cáncer colorectal. En cinco casos el tratamiento fue la resección simultánea de ambas neoplasias, dependiendo de la etapificación al momento de la cirugía. Conclusión: La existencia sincrónica de cáncer colorectal y tumor renal es una asociación rara. En este estudio se muestra una prevalencia de 0,86 por ciento de asociación de tumor renal en pacientes con diagnóstico de cáncer colorectal, El tratamiento simultáneo de ambas patologías es posible y seguro, dependiendo de la etapificación de las neoplasias.

Multicentric squamous cell carcinoma over lesions of porokeratosis palmaris et plantaris disseminata and giant porokeratosis.

Porokeratosis is a specific disorder of keratinization that has five clinical types and shows a characteristic 'cornoid lamella' on histopathology. Malignant degeneration has been described in all forms of porokeratosis. To the best of our knowledge, this is the first Indian report of multicentric squamous cell carcinoma complicating porokeratosis.

Synchronous gastric stromal tumor and cecal adenocarcinoma.

Gastrointestinal stromal tumors are rare intestinal tumors. There have been reports of this tumor occurring with other conditions and tumors. We report a 55-year-old man who presented with a gastric stromal tumor and cecal adenocarcinoma, necessitating right hemicolectomy and partial gastrectomy at the same sitting.

Neoplasias primárias múltiplas em pacientes com câncer colorretal / Multiple primary neoplasms in colorectal cancer patients

INTRODUCTION: Multiple primary neoplasms are defined as a second malignance having histology and site different from the first. The increase of the life expectation in cancer patients leads to an increase in multiple primary neoplasms incidence. This study analyzes the characteristics of patients with colorectal cancer and another primary neoplasms. PATIENTS AND METHODS: In the period from 1993 to 1998, 145 patients with colorectal cancer were accompanied in the Oncology Division of Gastroenterology of Federal University of Sao Paulo, Sao Paulo, SP, Brazil. Five patients (3.4 per cent) had multiple primary neoplasms. The possibility of metastasis were excluded and the second cancer was confirmed by hystological examination. RESULTS: The medium age was of 60.6 years old, four were female and one male. Three had rectum cancer and two colon cancer, one in the right colon and one in the left colon. The other site of cancer was breast, uterus, uterus and vagina, skin and lip. One patient died and the others were in attendance, two for more than three years. Two patients received pelvic radiotherapy before the rectal cancer. In one patient the tumor colorectal cancer appeared before the other cancer, and in four it appeared later on to the diagnosis of the other primary neoplasia. DISCUSSION: The prevalence of multiple primary neoplasms was of 3.4 per cent, being major in female. Uterus' cancer was the more frequent association. Radiotherapy was performed in 40 per cent of patients. We believe that attendance of cancer patients is very important to precocious diagnosis and treatment of multiple primary neoplasms

Squamous cell carcinoma of the esophagus and multiple primary tumors of the upper aerodigestive tract

Squamous cell carcinoma of the esophagus is frequently associated with other, synchromous or metachromous tumors, in the upper aerodigestive tract. All 264 patients with squamous cell carcinoma of the esophagus, treated in the Gastrointestinal Surgery> esophagus section, of the "Hospital das Clínicas" (São Paulo University Medical School, Brazil) between 1979 and 1989 were analyzed retrospectively with regards to the occurrence of multiple primary tumors in the upper aerodigestive tract. Multiple primary tumors were encountered in 10 (3.8 per cent) patients. All patients were male and the mean age at the time of the first primary was 52.2 years. Tobacco smoke and alchool were the principal carcinogens in these patients (n = 10). The sites of the tumors were: larynx (n = 4), tongue (n = 4), lung (n = 2), and oral cavity (n = 1). Two simultaneous, three synchronous and five metachronous multiple primary carcinoma were detected. The esophagus was the second primary tumor in nine patients. The mean overall survival after the diagnosis of the second primary was 2.8 months (SD = 0.89). Inquiry regarding other malignancies, associated with panendoscopy should be carry out prior to the treatment of the first primary to diagnose simultaneous or synchromous primary tumors, and careful follow-up should be performed after treatment of the first primary to detect new tumors in these high-risk patients.

Clinical characteristics of metachronous bilateral testicular tumors in the chemotherapeutic era

We wanted to present the results of our experience with bilateral testis tumor and to suggest the effects of chemotherapy in suppressing the development of second primary testicular tumors. Between 1978 and 1997, 2,345 patients were treated for testicular tumor at The University of Texas M. D. Anderson Cancer Center. Of these, 2,107 had germ cell cancers. There were 22 (0.94%) cases of bilateral testicular tumor in the overall patient population and 21 (1.0%) cases among patients with germ cell cancer. We reviewed the medical records to determine the incidence of the histological subtype, the incidence of metachronous versus synchronous formation of contralateral tumors, and tumor stage in this patient population. We also examined the effect of chemotherapy in treating the first tumor and preventing the occurrence of a second tumor. Finally, we compared the effect of ultrasonography, serum tumor marker elevation, and physical examination in detecting second tumors. Only one contralateral germ cell tumor developed synchronously; all others developed metachronously. Fifty percent of first tumors were seminomas, compared to 55% of second tumors. The histologic concordance rate for first and second tumors was 35%. Tumor stage was higher among first tumors than second tumors. The majority of second tumors in patients who received chemotherapy for first malignancies tended to be metachronous seminomas. Ultrasonography detected 6 of 21 (28.6%) contralateral tumors before they were evident by physical examination or serum tumor marker elevation. Seminomas were more prevalent among patients with bilateral germ cell disease than patients with unilateral disease. Chemotherapy, when used as treatment for first tumors, may have some effect in preventing the development of nonseminomatous germ cell tumors in the contralateral testicle. Close follow-up of the contralateral testis with ultrasonography is essential for early detection of second tumors. The outcome for patients with bilateral testicular germ cell cancer is excellent, secondary to early detection.

Cáncer de colon en el Instituto Nacional de Nutrición. II. Tumores sincrónicas y metacrónicos / Colonic cancer at the Instituto Nacional de nutrición. II synchrounous and metachronous carcinomas

Objetivo. Determinar, mediante una revisión retrospectiva, la frecuencia, localización, latencia y estudio de tumores sincrónicos y metacrónicos en pacientes con cáncer de colon manejados en el Instituto Nacional de la Nutrición Salvador Zubirán durante el período de 1979 a 1989. Resultados. Tumores sincrónicos: se encontraron 9 casos de 123 estudiados (7.2 por ciento). La edad promedio fue de 63 años (26 a 78 años); cuatro eran hombres y cinco mujeres. Su localización y estadio fue: transverso + sigmoides (B1+A), ascendente ambos (C2+A), transverso + recto (B3+A), descendente ambos (B2+A), sigmoides + descendente (A+A), transverso + descendente (B2+B2), ascendente + sigmoides (D+B), sigmoides ambos (B1+A) y ascendente + transverso (B+B2). En cuatro pacientes (44 por ciento) la presencia del tumor sincrónico modificó el tratamiento quirúrgico. Tumores metacrónicos: se detectaron 2 casos (3.2 por ciento) en 61 pacientes sometidos a cirugía con intento curativo y con seguimiento mayor a un año. El tiempo de latencia fue de 16 y 23 meses y su estadio en un caso fue de carcinoma in situ y en el otro A. conclusiones: La frecuencia de tumores sincrónicos y metacrónicos es similar a lo publicado en series anglosajonas, aunque el tiempo de latencia fue menor. Se hace énfasis en la necesidad de llevar a cabo colonoscopía preoperatoria y en el seguimiento de pacientes con cáncer de colon

A 18 years study of testicular tumours in Jodhpur, western Rajasthan.

The present study based on WHO histologic typing of testicular tumours deals with 100 cases recorded in the files of the Department of Pathology from 1969 to 1987. These tumours accounted for 2.57% malignancies of male genital system. Maximum number of tumours were recorded in the third and fourth decades. Right testis was affected in 60% cases. Scrotal swelling was the predominant presenting feature, followed by pain. Five cases of testicular tumours were observed in undescended testis. Germ cell tumour of one histologic type constituted 76% of testicular tumors. Germ cell tumors of more than one histologic type were 23%. One case (1%) belonged to lymphoid and haemopoietic system and was of large cell lymphocytic lymphoma. Amongst the germ cell tumors with one histologic type, seminoma (34%) and embryonal carcinoma (28%) were predominant while teratocarcinoma was a predominant tumour in combination group.

Estudio de neoplasias primarias múltiples en pacientes ingresados al Instituto de Radiomedicina; 1977-1990 / Study of multiple primary neoplasia in patients admitted in the Institute of Radiomedicine

Las neoplasias primarias múltiples son entidades clínicas caracterizadas por el desarrollo de dos o más neoplasias primarias de acuerdo a criterios básicos bien establecidos. En general, puede decirse que un 5 a 10% de los enfermos portadores de cáncer tienen mayor riesgo de presentar un nuevo tumor maligno, incidencia que es superior a la esperada en la población general. Los autores encuentran 87 casos de neoplasias primarias múltiples registradas en los archivos del IRAM, entre los años 1977 y 1990, de los cuales estudian 61. Se demuestra un aumento en la frecuencia de las neoplasias primarias múltiples en el período investigado con una incidencia de 0,79% comparable a la comunicada por otros autores. En la casuística predominan los tumores sólidos destacando los carcinomas (95,2%), de mama y cuello uterino. La edad promedio de diagnóstico de ambas neoplasias no presentó diferencias significativas según sexo. Las asociaciones de neoplasias primarias encontradas en este material son concordantes con lo señalado en la literatura. Los casos en los que la primera neoplasia fue tratada quirúrgicamente exhibieron períodos de latencia previos a la aparición meta crónica de la segunda lesión mayores que cuando se utilizó radioterapia sola o asociada

Sociedad de Cirujanos de Mar del Plata: cáncer múltiple de colon y recto / Surgeons' Society of Mar del Plata: multiple cancer of colon and rectum

El objetivo de este trabajo es determinar la prevalencia de cáncer múltiplo colorrectal, sus características y comparar la sobrevida acturial con la del cáncer único. Se revisaron las historias clínicas de 697 pacientes con cáncer de colon en el período 1971-1987, encontrando-se una prevalencia de 2,5// (n=16). Grupo A: tumores sincrónicos (n=9) 1,41//, diagnósticados por colon por enema. La localización más frecuente del primer tumor es el ciego y del segundo el sigmoides. El estadio de Dukes más frecuente del primer tumor fue el B y del segundo el A. El patrón histológico más frecuente fue el adenocarcinoma semidiferenciado. Las lesiones asociadas fueron: 5 pólipos adenomatosos y 2 pólipos vellosos. Grupo B: tumores metacrónicos (n-7) 1,09//, diagnosticados por colon por enema. El tiempo entre el daignóstico del primer y segundo tumor fue de 40 ñ 15 meses. La localización preferencial del primer tumor fue recto superior. El estadio de Dukes más frecuente fue el B y para el grado histológico los semidiferenciados. La localización preferencial del segundo tumor fue el sigmoides. Para el estadio de Dukes y grado histológico igual que el primer tumor. El análisis de la sobrevida actuarial se realizó teniendo en cuenta: a) sobrevida global y b) grado histológico más frecuente. En el grado A la sobrevida fue de 89 ñ 10// en el primer año y 74 ñ 16// a los 3 años y para los tumores semidiferenciados en el primer año 87 ñ 12// y a los 3 años 73 ñ 16//. En el grupo B la sobrevida global a los 3 años fue de 71 ñ 17// y para los tumores semidiferenciados fue de 67 ñ 19//. Concluimos que el cáncer múltiple correctal es una patología poco frecuente, pero no despreciable. No existen diferencias estadísticamente significativas en cuanto a sobrevida global y grado histológico entre tumores sincrónicos y metacrónicos comparada con el cáncer único