Bazo metastásico de un adenocarcinoma de endometrio. Presentación de un caso / Splenic metastasis from endometrial adenocarcinoma. A case presentation

Introducción: La metástasis esplénica de un carcinoma endometrial es un acontecimiento clínico raro, con solo 13 casos documentados en la literatura, revisada. La evolución de esta metástasis, en una paciente atendida, en nuestra Institución, fue el motivo para publicar este trabajo. Hay otras enfermedades oncológicas que en su evolución de progresión o recaída cursan con este tipo de cuadro clínico donde el tratamiento quirúrgico es fundamental y así complementar con tratamiento de quimioterapia. Se hizo una revisión en publicaciones cubanas no se encontró reporte del tema. Objetivo: Presentar un caso con un adenocarcinoma de endometrio tipo endometroide que metastiza al bazo con histología de células claras. Presentación: Paciente de 45 años, con diagnóstico de adenocarcinoma de endometrio con estadiamiento quirúrgico pT3A Nx Mo etapa IIIA Grado 2; este estadiamiento es el anterior a 2009, llevó su tratamiento quirúrgico y radioterapia complementaria, controlada por 21 meses. En consulta de seguimiento se diagnostica metástasis al bazo, por lo que se realiza esplenectomía y es tratada con quimioterapia; fue atendida por el equipo multidisciplinario de ginecología oncológica; las investigaciones realizadas estuvieron basadas en inmuhistoquimica, imageneología y tratamiento de soporte cuando lo necesitó. Conclusiones: La metástasis esplénica por un cáncer de endometrio es rara, es el primero reportado en Cuba, los estudios inmuhistoquímicos y de imágenes son fundamentales(AU)

Introduction: Splenic metastasis from endometrial carcinoma is a rare clinical event with only 13 documented cases in the literature reviewed. The evolution of a patient with this metastasis attended in our institution was the reason that motivated us to publish this work. There are other oncological diseases that are accompanied by this clinical picture during their evolution of progression where surgical treatment complemented with chemotherapy treatment is essential. A literature review was carried out in Cuban publications, but no reports on the topic were found. Objective: The aim of this work is to present an endometroid type case endometrium adenocarcinoma which metastasizes to the spleen with clear cell histology. Case presentation: Forty-five-year-old patient with diagnosis of endometrium adenocarcinoma with surgical stage pT3a Nx Mo stage IIIA Grade 2; this quantification was defined before 2009. The patient underwent surgical treatment which was complemented with radiotherapy and then followed for 21 months. In the follow-up consultation, spleen metastasis was diagnosed; so she underwent splenectomy and was treated with chemotherapy. She was treated by the multidisciplinary gynecologic oncology team; the investigations performed were based on immuhistochemistry, imaging, and supportive treatment whenever needed. Conclusions: Splenic metastasis from endometrial cancer is rare; it is the first case reported in Cuba. Immuhistochemical and imaging studies are essential(AU)

Linfoma marginal del bazo asociado a acidosis láctica tipo B: Caso clínico / Type B lactic acidosis associated with marginal lymphoma of the spleen: Report of one case

Lactic acidosis in the absence of hypoxia or tissue hypoperfusion (type B) is very rare and is associated with the use of some drugs or malignancy. We report a 79-year-old woman, with a marginal non-Hodgkin's lymphoma of the spleen that was subjected to a splenectomy one year ago. She presented with unexplained tachypnea associated with pancytopenia and elevation of IgM to 10 times over the higher normal limit. Laboratory tests showed the presence of metabolic acidosis and high lactic acid levels in the absence of infection, tissue hypoxia or hypoperfusion. She was treated with sodium bicarbonate and steroids without obtaining a reduction in lactate levels. Twelve days after admission, a single dose of Rituximab quickly normalized lactate concentrations and platelet count. After the fourth dose of Rituximab, pancytopenia disappeared and IgM fell to 25% of its baseline concentration.

Enfermedad de hígado poliquístico asociado con quiste esplénico / Polycystic liver disease associated with splenic cyst

La enfermedad poliquística del hígado en el adulto es una condición infrecuente y benigna, autosómica dominante, asociada con frecuencia a enfermedad poliquística renal. Se caracteriza por la formación de quistes hepáticos numerosos, con o sin afectación renal. Algunos otros factores probablemente implicados en su génesis son la edad, sexo femenino, embarazo, y el uso de anticonceptivos orales. Las terapias quirúrgicas incluyen la aspiración percutánea del quiste con el escleroterapia, fenestración laparoscópica, fenestración laparotómica, la resección del hígado y el trasplante del hígado. Caso: Hombre de 50 años de edad con diagnóstico de hígado poliquístico asociado a un quiste esplénico diagnosticado por TAC abdominal y que se trató con una técnica de videoloparoscopia. Conclusión: La intervención quirúrgica para la enfermedad del hígado poliquístico sintomático se ha asociado a una morbilidad significativa. La fenestración videolaparoscópica de los quistes es un método seguro y extremadamente efectivo y se debe considerar como tratamiento inicial para la enfermedad del hígado poliquístico.

Polycystic liver in the adult is a rare and benign, autosomal dominant disorder, frequently associated with renal polycystic disease. It is distinguished by formation of numerous hepatic cysts, with or without renal involvement. Some other factors are also thought to be involved in its genesis, such as age, female gender, pregnancy, and the use of oral birth control pills. Surgical therapies include percutaneous cyst aspiration with sclerotherapy, laparoscopic fenestration, open fenestration, liver resection and fenestration and liver transplantation. Case: Polycystic liver disease associated with splenic cyst was diagnosed in a 50 years old man by abdominal computed tomography imaging and videolaparoscopic finding. Conclusion: Surgical intervention for symptomatic polycystic liver disease has been associated with significant morbidity. Laparoscopic cysts fenestration was safe and extremely effective and should be considered as initial treatment for polycystic liver disease.

Membranoproliferative glomerulonephritis in a carcinoma with unknown primary: an autopsy study.

Kidney disease frequently complicates malignancy and its treatment. Although many solid and hematologic cancers may involve the renal parenchyma, clinical sequelae are usually not prominent. Published reports cite membranous nephropathy as the most common malignancy-associated glomerulopathy, occurring with many carcinomas and occasionally with leukemia and lymphoma followed by minimal change disease. Rarely membranoproliferative glomerulonephritis (MPGN) has been reported in patients with malignancy. The mechanism by which malignancy induces disease remains unproved, but may involve deposition of tumor antigen in the subepithelial space with in situ immune complex formation and subsequent complement activation. Treatment of the underlying malignancy may lead to resolution of nephrotic syndrome, lending indirect support to this theory. We report a rare autopsy case of a patient with metastatic carcinoma (with unknown primary) associated with MPGN. The association between MPGN and metastatic carcinoma with unknown primary is uncommon and has not been previously reported in the literature.

Linfomas em pacientes com a forma hepatoesplênica da esquistossomose mansônica / Lymphoma in patients harboring hepatosplenic mansonic schistosomiasis

RACIONAL: Cada vez mais se estabelece a correlação entre agentes infecciosos e doenças linfoproliferativas, sobretudo vírus e bactérias, através da ativação de linfócitos. OBJETIVO: Descrever 6 novos casos, de uma série de 254 pacientes (2,36 por cento) com esquistossomose mansônica na forma hepatoesplênica. CASUÍSTICA E MÉTODOS: São descritos 6 pacientes, dentre os 254 portadores de esquistossomose mansônica na forma hepatoesplênica, acompanhados nos últimos 13 anos no Serviço de Cirurgia Geral do Hospital das Clínicas da Universidade Federal de Pernambuco, Recife, PE. RESULTADOS: Todos os seis casos ocorreram em mulheres. Os exames histopatológicos evidenciaram dois casos de linfomas de zona marginal esplênica, um de linfoma de grandes células com imunoblastos, um de linfoma difuso de grandes células, um de linfoma maligno de grandes células não clivadas, e um outro caso de doença de Hodgkin. Metade das seis pacientes evoluiu para o óbito entre 4 a 15 meses após o diagnóstico. As outras três persistem em acompanhamento no Serviço de Oncologia da mesma instituição. CONCLUSÃO: A incidência de linfoma nos 254 pacientes acompanhados foi de 2,36 por cento. Pretende-se chamar a atenção para a ocorrência de linfomas nos baços de pacientes com esquistossomose mansônica, na forma hepatoesplênica.

BACKGROUND: Correlation between infectious agents and linfoproliferative diseases are more stablished, over all virus and bacteria, through the activation of linfocytes. AIM: To describe six new cases, of a series of 254 patients (2,36 percent) with mansonic schistosomiasis, in the hepatosplenic form. METHODS: Six patients will be described, amongst the 254 carriers of mansonic schistosomiasis, in the hepatosplenic form, followed in the last 13 years. RESULTS: All the six cases had occurred in women. The histopathologic examinations had evidenced two cases of marginal splenic zone lymphomas, one of great cells with immunoblasts lymphomas, one diffuse lymphomas, a great cells malignant lymphomas, a great not clivads cells, and another case of Hodgkin. Half of the six evolved for the death 4-15 months after the diagnosis. The others three persist in accompaniment in the Oncology Division of the Clinics Hospital. CONCLUSION: The incidence of lymphomas in the 254 mansonic schistosomiasis patients followed in our clinic was of 2,36 percent. At last, this article intends to call the attention, for the occurrence of lymphomas, in the spleen of patients with mansonic schistosomiasis, in the hepatosplenic form.

Littoral Cell Angioma (LCA) Associated with Liver Cirrhosis

A littoral cell angioma (LCA) is a rare benign vascular tumor of the spleen. A 60-year-old man, with multiple nodules in imaging study and liver cirrhosis graded as Child-Pugh classification class A, was transferred for splenomegaly. A thrombocytopenia was found on hematological evaluation. Because there was no evidence of hematological and visceral malignancy, a splenectomy was performed for a definitive diagnosis. The histological and immunohistochemical features of the splenic specimens were consistent with a LCA. After the splenectomy, the thrombocytopenia recovered to the normal platelet count. There has been no previous report of a LCA combined with liver cirrhosis. Herein, the first case of a LCA in Korea, diagnosed and treated by a splenectomy, is reported.

Splenic lymphangioma and presentation with frequent urination: a case report.

Lymphangioma of the spleen is a rare disorder with a clinical manifestation ranging from incidental findings of an abdominal mass to symptomatic abdominal pain. The authors reported a case of splenic lymphangioma with the presenting symptom of frequent urination in a 9-year-old boy. A large firm mass was found at the left upper quadrant, 12 cm in diameter. The diagnosis was confirmed by ultrasonography and computerized tomographic (CT) scan. The symptoms of frequent urination disappeared after operative splenectomy. No evidence of recurrence occurred over a 3-year follow-up.

Hepatosplenic B-cell lymphoma associated with hemophagocytic syndrome: a case report

While T-cell non-Hodgkin's lymphoma (NHL) associated with hemophagocytic syndrome (HPS) has been frequently observed, B-cell NHL associated with HPS has been rarely reported. We report a case of hepatosplenic B-cell lymphoma associated with HPS in a 41-year-old woman who presented with fever of unknown origin. An abdominal CT scan revealed splenomegaly with focal splenic infarction. Splenectomy and a liver wedge biopsy showed sinusoidal-pattern infiltration of medium to large tumor cells with positive reaction to a B-lymphocyte marker. Findings on bone marrow examination showed proliferation of histiocytes with avid hemophagocytosis.

Splenic cystic lymphangiomatosis: an unusual cause of massive splenomegaly: report of a case.

A 29-year-old woman had a history of an upper quadrant abdominal mass for about 6 years. An ultrasound examination revealed splenomegaly containing several cysts. On exploratory laparotomy, multiple cysts were found in the spleen. Because of the extensive involvement of the spleen, splenic salvage could not be performed, and total splenectomy was done. Both morphological and histological features of the removed spleen were typical of cystic lymphangiomatosis.

Splenic hamartoma with portal hypertension: a case report.

A case of splenic hamartoma arising from the upper pole of the spleen and presenting with upper abdominal pain, ascites and pedal edema is presented. Splenectomy was performed. The histopathology, revealed splenic hamartoma of pulposal type.

Hemangioma y pseudioquiste esplénico

Reportamos el caso de una paciente de 17 años de edad, portadora de un hemangioma y pseudoquiste esplénico cuyo hallazgo fue casual en una tomografía axial computarizada de abdome, dirigida a evaluar una malformación congénita de vías urinarias, consistente en una duplicación del uréter derecho, la cual se había complicado con una obstrucción