Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 46
Chinese Journal of Pathology ; (12): 1013-1018, 2022.
Article in Chinese | WPRIM | ID: wpr-952703


Objective: To investigate the clinical features, morphological characteristics, immunophenotype, and differential diagnosis of goblet cell adenocarcinoma (GCA) in the digestive system. Methods: The clinicopathological data, morphological characteristics, immunophenotypes of 22 cases of GCA in the digestive system diagnosed from January 2010 to January 2021 were collected. Meanwhile, 25 cases of neuroendocrine neoplasm (NEN) and 24 cases of adenocarcinoma were used as controls. Relevant literature was also reviewed. Results: There were 16 males and 6 females, aged from 36 to 79 years with an average of 56 years. The anatomical sites of the 22 GCA were mostly appendix (17 cases) and occasionally extra-appendix (5 cases), including 3 cases in stomach, 1 case in duodenum and 1 case in anal. All 17 cases of appendiceal GCA were pure GCA. Among the 5 cases of extra-appendiceal GCA, One case of gastric GCA was pure, two cases of gastric GCA with NEN or adenocarcinoma, duodenal GCA with NEN and adenocarcinoma, anal GCA with NEN.Low-grade GCAs were composed of goblet, Paneth and neuroendocrine cells, which were arranged in intestinal crypt tubular or cluster structures and distributed in the wall of digestive system. The tubular and cluster structures lacked adhesion. Goblet cells were columnar, located in the base, with clear cytoplasm, small nuclei, inconspicuous atypia, and uncommon mitoses. Extracellular mucus and signet-ring cells with nuclear variations could be seen in some cases. Nerve fiber bundle invasion and tumor thrombus in vessels were often present. High-grade GCAs lacked tubular and cluster structures, and their histological structures were more complex. Tumor cells expressed mixed neuroendocrine and glandular epithelial markers. Similar to the expression patterns of synaptophysin and chromogranin A, CD200 and INSM1 were also dot-like or patch-positive in GCA. Conclusions: GCA is an infrequent tumor of the digestive system and shows the bi-directional differentiation characteristics of neuroendocrine and glandular epithelium. Accurate diagnosis and staging are related to its prognosis.

Adenocarcinoma/pathology , Appendiceal Neoplasms/surgery , Carcinoid Tumor/surgery , Chromogranin A , Female , Goblet Cells/pathology , Humans , Male , Neuroendocrine Tumors/pathology , Repressor Proteins , Synaptophysin
Article in Chinese | WPRIM | ID: wpr-943028


Objective: To analyzed perioperative safety of cytoreductive surgery (CRS) for patients with colorectal cancer peritoneal metastasis (CRPM) and to construct a predictive model for serious advese events (SAE). Methods: A descriptive case-series study was conducted to retrospectively collect the clinicopathological data and treatment status (operation time, number of organ resection, number of peritoneal resection, and blood loss, etc.) of 100 patients with peritoneal metastases from colorectal cancer or appendix mucinous adenocarcinoma who underwent CRS at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2019 to August 2021. There were 53 males and 47 females. The median age was 52.0 (39.0-61.8) years old. Fifty-two patients had synchronous peritoneal metastasis and 48 had metachronous peritoneal metastasis. Fifty-two patients received preoperative neoadjuvant therapy. Primary tumor was located in the left colon, the right colon and the rectum in 43, 28 and 14 cases, respectively. Fifteen patients had appendix mucinous adenocarcinoma. Measures of skewed distribution are expressed as M (range). Perioperative safety was analyzed, perioperative grade III or higher was defined as SAE. Risk factors associated with the occurrence of SAEs were analyzed using multivariate logistic regression. A nomogram was plotted by R software to predict SAE, the efficacy of which was evaluated using the area under the ROC curve (AUC) and correction curves. Results: The median peritoneal cancer index (PCI) score was 16 (1-39). Sixty-eight (68.0%) patients achieved complete tumor reduction (tumor reduction score: 0-1). Sixty-two patients were treated with intraperitoneal hyperthermic perfusion chemotherapy (HIPEC). Twenty-one (21.0%) patients developed 37 SAEs of grade III-IV, including 2 cases of ureteral injury, 6 cases of perioperative massive hemorrhage or anemia, 7 cases of digestive system, 15 cases of respiratory system, 4 cases of cardiovascular system, 1 case of skin incision dehiscence, and 2 cases of abdominal infection. No grade V SAE was found. Multivariate logistic regression analysis showed that CEA (OR: 8.980, 95%CI: 1.428-56.457, P=0.019), PCI score (OR: 7.924, 95%CI: 1.486-42.259, P=0.015), intraoperative albumin infusion (OR: 48.959, 95%CI: 2.115-1133.289, P=0.015) and total volume of infusion (OR: 24.729, 95%CI: 3.956-154.562, P=0.001) were independent risk factors for perioperative SAE in CRS (all P<0.05). Based on the result of multivariate regression models, a predictive nomogram was constructed. Internal verification showed that the AUC of the nomogram was 0.926 (95%CI: 0.872-0.980), indicating good prediction accuracy and consistency. Conclusions: CRS is a safe and effective method to treat CRPM. Strict screening of patients and perioperative fluid management are important guarantees for reducing the morbidity of SAE.

Adenocarcinoma, Mucinous/therapy , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Appendiceal Neoplasms/surgery , Colorectal Neoplasms/pathology , Combined Modality Therapy , Cytoreduction Surgical Procedures/methods , Female , Humans , Hyperthermia, Induced/methods , Male , Middle Aged , Peritoneal Neoplasms/secondary , Retrospective Studies , Survival Rate
Rev. chil. obstet. ginecol. (En línea) ; 86(3): 317-321, jun. 2021. ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388654


Resumen Los adenomiomas son tumoraciones benignas constituidas por un agregado nodular de músculo liso, glándulas endometriales y estroma endometrial. La presencia de adenomiomas fuera del útero es un hallazgo infrecuente. Presentamos dos casos de adenomiomas extrapélvicos localizados en el apéndice. El estudio histológico resultó esencial para el diagnóstico.

Abstract Adenomyomas are a benign tumor compound of smooth muscle nodular aggregate, endometrial glands and endometrial stroma. Adenomyomas presenting outside uterus are a rare finding. Here we report two extrapelvic adenomyomas of the appendix. Histological examination was essential for diagnosis.

Humans , Female , Adult , Middle Aged , Appendiceal Neoplasms/pathology , Adenomyoma/pathology , Appendiceal Neoplasms/surgery , Appendiceal Neoplasms/diagnosis , Adenomyoma/diagnosis , Adenomyosis , Adenomyosis/surgery
Rev. venez. cir ; 74(1): 10-12, 2021. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1283697


El mucocele apendicular es la dilatación quística del apéndice con acumulación de material mucinoso. Su forma de presentación más frecuente es dolor en fosa ilíaca derecha, sin embargo, la mitad de los casos son asintomáticos. En el presente trabajo se presenta caso de un paciente con diagnóstico incidental de mucocele apendicular, al cual se le realizó apendicectomía laparoscópica como tratamiento definitivo. Caso clínico: Paciente masculino de 44 años sin antecedentes patológicos conocidos, quien se realiza ultrasonido abdominal que informa tumor quístico en fosa ilíaca derecha. Se decide resolución quirúrgica laparoscópica. Informe histológico: mucocele apendicular sin evidencia de malignidad y recuperación satisfactoria del paciente. Conclusión: La neoplasia mucinosa del apéndice es una patología poco frecuente, puede presentarse con una variedad de manifestaciones clínicas hasta un hallazgo incidental. El tratamiento es fundamentalmente quirúrgico y el abordaje laparoscópico es de elección en pacientes sin evidencia de ruptura y diseminación de la enfermedad(AU)

The appendicular mucocele is a cystic dilation of the appendix with accumulation of mucinous material. The most frequent form of presentation is pain in the right iliac fossa; however, half of the cases are asymptomatic patients. In the present work we present a case of a patient with an incidentally diagnosis of appendicular mucocele who underwent laparoscopic appendectomy as definitive treatment. Clinical case: A 44-year-old male patient with no known pathological history, who underwent an abdominal ultrasound that reported a cystic tumor in the right iliac fossa. Laparoscopic surgical resolution was decided, the histological examination revealed appendicular mucocele without evidence of malignancy and satisfactory recovery of the patient. Conclusion: Mucinous neoplasia of the appendix is an uncommon pathology, patients are often asymptomatic or have nonspecific symptoms, and the diagnosis is made incidentally in the course of other examination. Treatment is primarily surgical and the laparoscopic approach is the choice in patients without evidence of rupture and dissemination of the disease(AU)

Humans , Male , Adult , Appendiceal Neoplasms/surgery , Ilium/pathology , Mucocele/pathology , Appendectomy , Drug Therapy , Mucocele
Article in Chinese | WPRIM | ID: wpr-943008


Objective: To investigate the clinicopathological features, surgical methods and prognosis of primary appendiceal neoplasms. Methods: A descriptive case series study was performed. Clinical data of patients diagnosed with primary appendiceal neoplasms in Peking University First Hospital from 2006 to 2017 were retrospectively analyzed. Patients who underwent surgery and were confirmed as appendiceal neoplasms by postoperative pathology were included. Cases of cecal tumor invading the appendix and other organ tumors implanting in the appendix and cases of recurrent appendix tumors were excluded Pathological classification was based on the 4th edition of the WHO classification of digestive tract tumors (2010 edition), and the efficacy of operation methods of low grade appendiceal mucinous neoplasm (LAMN) were analyzed. Results: A total of 115 patients were enrolled, including 52 males and 63 females with a median age of 59 (51, 71) years. Clinical symptoms usually manifested as dormant pain in the right lower quadrant, migrating right lower abdominal pain, fever and bloating. Twenty-four cases were accidentally discovered during surgery, and 21 cases were found by physical examination. The preoperative diagnosis rate of CT and ultrasound was 40.2% (43/107) and 25.5% (24/94) respectively. The postoperative pathological types contained 83 cases of LAMN, 12 cases of mucinous adenocarcinoma, 9 cases of appendiceal neuroendocrine neoplasms (aNEN), 2 cases of mucinous adenocarcinoma with signet ring cells, 3 cases of serrated adenoma, 2 cases of goblet cell carcinoid, 2 cases of lymphoma, 1 case of leiomyoma and 1 case of schwannomas. All the patients underwent surgical resection, including 41 cases of appendectomy, 21 cases of partial cecectomy, 48 cases of right hemicolectomy, and 5 cases of combined organ resection due to appendiceal tumor infiltration or dissemination. Eighteen cases were diagnosed with pseudomyxoma peritonei (PMP) during operation. A total of 98 patients were enrolled for follow-up. The median follow-up time was 58 (5-172) months. The 5-year disease-free survival (DFS) rate was 84.5% and 5-year overall survival (OS) was 88.2%. Multivariate analysis revealed that high-grade malignancy tumors (HR=25.881, 95% CI: 2.827-236.935, P=0.004) and PMP formation (HR=42.166, 95% CI: 3.470-512.439,P=0.003) were independent risk factors for prognosis. Patients undergoing right hemicolectomy presented longer operation time, more blood loss and higher morbidity of complication as compared to those undergoing appendectomy and partial cecectomy (all P<0.05), while no significant differences in 5-year DFS (P=0.627) and 5-year OS (P=0.718) were found. Conclusions: Primary appendiceal neoplasms usually have no typical features, accompanied with low preoperative diagnosis rate. The common pathological types are LAMN, mucinous adenocarcinoma and aNEN. Appendectomy or partial cecectomy for LAMN may achieve satisfactory prognosis. High-grade malignancy tumors and PMP formation are independent risk factors for prognosis.

Adenocarcinoma, Mucinous/surgery , Appendectomy , Appendiceal Neoplasms/surgery , Humans , Male , Neoplasm Recurrence, Local , Retrospective Studies
Rev. chil. cir ; 69(4): 297-301, ago. 2017. graf, tab
Article in Spanish | LILACS | ID: biblio-899605


Introducción: Los tumores del apéndice cecal son una patología infrecuente. De ellos, los adenocarcinomas apendiculares no superan el 0,1% de las apendicectomías. Objetivos: Describir el manejo y la sobrevida de pacientes con diagnóstico de adenocarcinoma apendicular en el Complejo Asistencial Dr. Sótero del Río. Materiales y métodos: Análisis retrospectivo descriptivo de pacientes operados de apendicectomía y diagnóstico patológico de adenocarcinoma apendicular entre enero de 2003 y diciembre de 2013. Se evaluaron características demográficas, síntomas, manejo y sobrevida. Resultados: Se analizaron un total de 14.582 apendicectomías. Se obtuvieron 84 biopsias positivas para tumores apendiculares primarios (0,58%). De este grupo, 9 biopsias correspondían a un adenocarcinoma apendicular (0,06%). Siete de los 9 pacientes poseían registro completo. La mediana de edad fue de 53 años. Seis pacientes cursaron con un cuadro de abdomen agudo. Se realizó una hemicolectomía derecha en 6 pacientes posterior al diagnóstico de adenocarcinoma. De ellos, 4 recibieron quimioterapia adyuvante. La sobrevida a 3 años fue del 58%. Conclusiones: El adenocarcinoma apendicular es un hallazgo poco frecuente durante una apendicectomía y se asocia a una sobrevida similar a la reportada internacionalmente.

Introduction: Appendiceal tumors are a rare pathology, not exceeding 0.1% of appendectomies. Objectives: Describe the management and survival of patients diagnosed with appendiceal adenocarcinoma at the Complejo Asistencial Doctor Sótero del Río. Materials and methods: Descriptive retrospective analysis of patients underwent appendectomy, with histopathologic diagnosis of appendiceal adenocarcinoma, in the period from January 2003 to December 2013. Demographic characteristics, symptoms, management and survival were evaluated. Results: Data from 14,582 appendectomies was analyzed; 84 positive biopsies for primary appendiceal tumors (0.58%) were obtained. Of this group, 9 biopsies corresponded to an appendiceal adenocarcinoma (0.06%). Seven of the 9 patients had complete record. The median age was 53 years. Six patients presented with an acute abdomen. Right hemicolectomy underwent 6 patients. Of these, 4 received adjuvant chemotherapy. The 3-year survival was 58%. Conclusions: Appendiceal adenocarcinoma is a rare finding during an appendectomy and is associated with a low overall survival.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Appendiceal Neoplasms/surgery , Appendiceal Neoplasms/mortality , Adenocarcinoma/surgery , Adenocarcinoma/mortality , Appendectomy/mortality , Appendiceal Neoplasms/pathology , Biopsy , Adenocarcinoma/pathology , Survival Analysis , Retrospective Studies , Colectomy
Rev. chil. cir ; 69(1): 65-68, feb. 2017. ilus
Article in Spanish | LILACS | ID: biblio-844327


Introducción: La apendicitis es uno de los principales motivos de consulta e intervención quirúrgica en los servicios de urgencias. Debe tratarse oportunamente dado que puede evolucionar hacia una perforación apendicular y con ello a una peritonitis o un plastrón apendicular, en aproximadamente un 10%, e incrementando las morbilidades, como tiempo de reposo o estadía hospitalaria. Actualmente no existe consenso acerca del tratamiento del plastrón apendicular, por ello, el objetivo del presente trabajo es respaldar y promover la alternativa quirúrgica diferida, versus el manejo médico, como el tratamiento más idóneo del plastrón apendicular. Presentación del caso: Se derivó al Hospital Base Valdivia a una escolar, de 8 años y 11 meses de edad, por dolor en hemiabdomen inferior de 3 semanas de evolución acompañado de sensación febril no cuantificada, vómito y diarrea; se diagnosticó un plastrón apendicular, optándose por el manejo médico; evolucionó favorablemente, dándole el alta. En controles posteriores se planificó una apendicectomía, llevándose a cabo con éxito meses después. La biopsia del apéndice extraído evidenció un carcinoma de apéndice cecal, por lo que se inició el estudio de extensión de neoplasia sin encontrar hallazgos patológicos. Discusión: Actualmente el manejo del plastrón apendicular depende del médico tratante y su criterio. Existen ventajas y desventajas entre la elección de un tratamiento médico o quirúrgico, sea inmediato o diferido; dentro de las ventajas del último destacan la prevención de apendicitis recurrentes y detección temprana del carcinoma apendicular, como en el caso presentado, permitiendo de esta forma un mejor pronóstico para el paciente y evitando el uso de terapias más agresivas.

Introduction: Appendicitis is one of the main reasons for consultation and surgery in the emergency department. It must be treated promptly because it can evolve into a ruptured appendix and thus to peritonitis or an appendiceal plastron, by approximately 10%, and increasing the morbidity, as downtime or hospital stay. There is currently no consensus on the treatment of appendicular plastron, therefore, the objective of this work is to support and promote alternative deferred surgical versus medical management, as the most suitable treatment of appendiceal plastron. Case presentation: A girl of 8 years 11 months old consult for pain in lower abdomen of three weeks of evolution, accompanied by feverish feeling, unquantified, vomiting and diarrhea; Is diagnosed a plastron appendiceal opting for medical management, evolving favorably and giving the discharge. In subsequent controls was planned appendectomy, taking place successfully months later. Biopsy of removed appendix showed a appendix cancer, reason why an extension study of neoplasia was initiated without pathological findings. Discussion: Currently the management of appendicular plastron is dependent on the treating physician and judgment. There are advantages and disadvantages of choosing a medical or surgical treatment, immediate or delayed, inside the advantages of the latter include the prevention of recurrent appendicitis and early detection of appendiceal carcinoma, as in the case presented, thus allowing better prognosis for the patient and avoiding the use of more aggressive therapies.

Humans , Female , Child , Appendectomy , Appendiceal Neoplasms/surgery , Carcinoma/surgery , Abdomen, Acute/etiology , Appendicitis
Rev. chil. cir ; 68(4): 319-322, jul. 2016. ilus
Article in Spanish | LILACS | ID: lil-788901


Objetivo Exposición de 3 casos tratados quirúrgicamente en nuestra clínica. Casos clínicos Caso 1: paciente mujer de 78 años con diagnóstico de quiste complejo de ovario derecho, se realizó la cirugía y se evidencia tumoración de apéndice cecal. Caso 2: paciente varón de 38 años con dolor abdominal crónico. Presenta marcador tumoral antígeno carcinoembrionario elevado, laparoscopia exploratoria evidencia líquido mucinoso peritoneal y tumoración apendicular. Caso 3: paciente mujer de 42 años con dolor crónico en fosa iliaca derecha con marcadores tumorales normales. Laparoscopia exploratoria evidencia tumoración dependiente del apéndice cecal con localización retrocecal ascendente. Discusión Se debe considerar a los mucoceles apendiculares dentro del diagnóstico diferencial de dolor en cuadrante inferior derecho del abdomen. Es preferible realizar una hemicolectomia radical para lesiones grandes y/o perforadas por el riesgo de existir cistoadenocarcinoma. El abordaje laparoscópico es una buena alternativa de manejo.

Objective We present three surgically treated cases in our hospital Case Reports Case 1: A 78 years old woman with a diagnosis of complex ovarian cyst. During surgery, an appendicular tumor was found. Case 2: A 38 years old male with chronic abdominal pain with high levels of carcinoembryonic antigen. During exploratory laparoscopy an appendicular tumor and mucinous peritoneal fluid were found. Case 3: A 42 years old woman with chronic pain in the right lower abdomen, negative tumor markers. During exploratory laparoscopy a retrocecal appendicular tumor was found. Discussion Appendiceal mucoceles should be considered in the differential diagnosis of right lower abdominal pain. If the lesions are big or perforated, a radical hemicolectomy should be performed due to the risk of a cystadenocarcinoma. Laparoscopic approach is a good alternative for management.

Humans , Male , Female , Adult , Aged , Appendiceal Neoplasms/surgery , Laparoscopy , Cystadenocarcinoma, Mucinous/surgery , Appendiceal Neoplasms/diagnosis , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Abdominal Pain/etiology , Cystadenocarcinoma, Mucinous/diagnosis
Rev. chil. cir ; 65(6): 509-514, dic. 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-698644


Background: The most common malignant appendicular neoplasm is the neuroendocrine well-differentiated tumor (NET). Other malignant tumors are uncommon, reported with a frequency of 0.2 percent of all appendectomies. Aim: To describe the characteristics of appendiceal malignant tumors found in regional hospitals of Northern Chile. Material and Methods: All patients operated for acute appendicitis between 2005 and 2011, in which a malignant appendiceal tumor was found in the pathological study, were analyzed. Clinical and survival information was obtained from medical records and national death registries. Results: We analyzed 8.972 appendectomy records. Appendicular tumors were found in 40 patients (0.4 percent). Thirty patients (0.3 percent) had malignant tumors. NET was the most common tumor found in 19 patients (63 percent). The tumor was smaller than 1 cm in 16 cases (53 percent). In 5 patients (17 percent), the tumor was larger than 2 cm with the appendicular base infiltrated by malignant cells. Most patients (83 percent) presented with stage I tumors. In 23 patients (77 percent, the appendectomy was considered sufficient and definitive treatment. Conclusions: In this series of patients, appendicular tumors had similar characteristics to those reported abroad. All patients had a favorable evolution without associated mortality or tumor relapse...

Introducción: El tumor apendicular maligno encontrado con mayor frecuencia es el tumor neuroendocrino bien diferenciado (NET). Otros tumores malignos se reportan con una frecuencia menor a 0,2 por ciento de todas las apendicectomías. El objetivo del presente estudio es describir las características de los tumores malignos del apéndice en la IV Región de Chile. Material y Método: Se estudió una cohorte histórica constituida por pacientes operados en los hospitales de La Serena, Coquimbo y Ovalle entre enero de 2005 y diciembre de 2011. Los resultados se reportan mediante estadística descriptiva. Resultados: Se estudiaron 8.972 apendicectomías. En 40 pacientes (0,4 por ciento) se diagnosticaron tumores apendiculares de los cuales 30 (0,3 por ciento) fueron malignos y fueron incluidos en este análisis. El tipo histológico maligno más frecuente fue el NET en 19 casos (63 por ciento). En 16 casos (53 por ciento) el tumor fue menor a 1 cm. En 5 casos (17 por ciento) el tumor fue mayor a 2 cm con compromiso de la base. La mayoría de los pacientes (83 por ciento) se presentaron con tumores en estadio I y los demás con tumores en estadio II. En 23 pacientes (77 por ciento) la apendicectomía fue considerada como el tratamiento definitivo. Conclusiones: Las características generales de los tumores malignos del apéndice en los pacientes operados por apendicitis en la IV Región de Chile son similares a las características reportadas en series nacionales e internacionales. En la presente cohorte, los pacientes tuvieron una evolución favorable sin mortalidad asociada al tumor y sin recurrencias conocidas hasta la fecha actual...

Humans , Male , Female , Appendectomy/statistics & numerical data , Appendiceal Neoplasms/surgery , Appendiceal Neoplasms/epidemiology , Chile , Follow-Up Studies , Appendiceal Neoplasms/pathology , Retrospective Studies , Survival Rate
Rev. chil. cir ; 65(1): 60-63, feb. 2013. ilus
Article in Spanish | LILACS | ID: lil-665557


Introduction: Appendiceal mucocele are lesions located in the cecum, which are found in 0.2 to 0.3 percent of appendectomies and correspond to 8-10 percent of all appendiceal tumors. Clinical case: We report a 83 years old female consulting for abdominal pain lasting 24 hours. On physical examination, signs of peritoneal irritation were found. The patient was operated, finding an appendiceal tumor that was coiled up in the mesentery with large bowel gangrene. An intestinal resection, terminal ileostomy, appendectomy and surgical lavage were performed. The pathological study of the surgical piece reported a mucinous cystadenoma.

Introducción: Los tumores del Apéndice Cecal corresponden al 0,5 por ciento de las neoplasias gastrointestinales y se encuentran entre el 0,8 por ciento y el 1 por ciento de las apendicectomías. El término Mucocele Apendicular (AM), se refiere a un grupo de lesiones localizados a nivel del ciego cuyo rango de incidencia está entre el 0,2 por ciento y el 0,3 por ciento de todas las apendicectomías, y entre el 8-10 por ciento de todos los tumores apendiculares. Las presentaciones clínicas más frecuentes son: cuadro clínico de apendicitis aguda, como hallazgo incidental como en el caso de esta paciente, o como masa abdominal en fosa ilíaca derecha. Caso clínico: Se presenta un caso de Cistade-noma Mucinoso Apendicular (CAM) encontrado como hallazgo incidental en un abdomen agudo quirúrgico con la particularidad de presentarse con una necrosis intestinal.

Humans , Female , Aged, 80 and over , Cystadenocarcinoma, Mucinous/surgery , Cystadenocarcinoma, Mucinous/complications , Intestinal Diseases/etiology , Gangrene/etiology , Appendiceal Neoplasms/surgery , Appendiceal Neoplasms/complications , Appendicitis , Intestinal Diseases/surgery , Gangrene/surgery , Intestines/pathology , Necrosis
Rev. chil. cir ; 64(3): 289-291, jun. 2012.
Article in Spanish | LILACS | ID: lil-627113


We report a 73 years old woman presenting with a right ovarian tumor. Preoperative carcinoembryonic antigen and CA-125 levels were above normal levels. The patient was operated, performing a bilateral oopho-rectomy an appendectomy. The pathological study of the surgical piece reported a mucinous ovarian cystic adenocarcinoma that infiltrated the wall but did not reach the capsule. A mucinous cystadenoma was found in the contralateral ovary. A mucinous adenocarcinoma was detected in the appendix, involving the wall but sparing the serosa. The patient was subjected to chemotherapy and six months after the first operation a tumor relapse was detected. A new excision was carried out and the patient continues with adjuvant chemotherapy. The ovarian an appendiceal tumors could be synchronic or a primary and secondary localization.

Introducción: El cistoadenocarcinoma de apéndice es una neoplasia poco frecuente. La asociación de tumores apendiculares y ováricos es conocida cuando existe pseudomixoma peritoneal. Sin embargo, la relación de la patogénesis entre los tumores es todavía desconocida. Caso clínico: Mujer de 73 años con clínica de plenitud postprandial y dispepsia de un año de evolución. La RMN abdómino-pélvica demuestra una gran tumoración de 15x13x9 cm, politabicada, con origen en ovario derecho. Presenta un CEA preoperatorio de 50 y un CA-125 de 30. Se realizó laparotomía infraumbilical con anexectomía bilateral y apendicectomía. El resultado anátomo-patológico informa de cistoadenocarcinoma mucinoso de ovario bien diferenciado que infiltra casi toda la pared, abierta, sin alcanzar la cápsula ovárica; el ovario contralateral presenta un cistoade-noma mucinoso; el apéndice cecal presenta adenocarcinoma mucinoso bien diferenciado, con infiltración de casi toda la pared, respetando la serosa. Discusión: Presentamos el caso de una tumoración pélvica con diagnóstico anátomo-patológico de cistoadenocarcinoma mucinoso de ovario. Asimismo se demuestra afectación de apéndice cecal por adenocarcinoma mucinoso. Nos planteamos, por tanto, la posibilidad de que se trate de una infiltración metastásica o dos tumores sincrónicos. Revisamos el concepto de cistoadenocarcinoma apendicular y ovárico, y analizamos los posibles mecanismos de asociación entre ellos. Conclusión: Destacamos la necesidad de una exhaustiva revisión de la cavidad abdominal ante este tipo de patología, dada su asociación con otros procesos neoplásicos intraabdominales.

Humans , Female , Aged , Adenocarcinoma, Mucinous/surgery , Adenocarcinoma, Mucinous/pathology , Ovarian Neoplasms/surgery , Ovarian Neoplasms/pathology , Appendiceal Neoplasms/surgery , Appendiceal Neoplasms/pathology , Appendectomy , Neoplasm Metastasis , Neoplasms, Multiple Primary , Pseudomyxoma Peritonei
Rev. chil. cir ; 62(6): 594-599, dic. 2010. ilus, tab
Article in Spanish | LILACS | ID: lil-577306


Background: Acute appendicitis can be the first manifestation of an appendiceal tumor. Aim: To evaluate the incidence of appendiceal tumors among patients operated for acute appendicitis. Material and Methods: All patients operated for acute appendicitis between 1998 and 2008 and whose appendix had a pathological study were included. Survival was calculated using national death register databases. Results: Data from 6.093 patients was analyzed. A malignant tumor was found in 17 patients (0.3 percent). Eleven patients aged 23 +/- 14 years had a carcinoid tumor, that was more commonly located distally, five patients aged 66 +/-18 years had an adenocarcinoma, that was more commonly located proximally, and one patient had a non Hodgkin lymphoma. Curative surgery was carried out in all carcinoid tumors and 40 percent of adenocarcinomas. No patient had regional lymph node involvement. Five years survival of patients with carcinoid tumors was 100 percent. Conclusions: The finding of malignant tumor among patients with acute appendicitis is uncommon.

Introducción: Al enfrentarnos a un paciente con apendicitis aguda, pocas veces pensamos que puede ser la primera manifestación de un cáncer apendicular. Objetivo: Describir el número de casos nuevos de cáncer apendicular en las apendicectomías de urgencia en el Hospital Base Osorno (HBO) durante los años 1998-2008. Material y Métodos: Serie de casos. Se incluyeron pacientes operados por abdomen agudo en el servicio de urgencia del HBO, que en cuyo informe anatomopatológico de la biopsia diferida se informara cáncer apendicular, entre los años 1998 y 2008. Se excluyeron pacientes en los que el apéndice estaba comprometido por contigüidad. Algunas variables incluidas: edad, sexo, diagnóstico preoperatorio, tipo de cirugía, resección completa tumoral, reintervención, características histoanatomopatológicas, terapia adyuvante. Descripción de variables en porcentajes, medias o medianas. Curvas de sobrevida: Kaplan Meier. Programa estadístico Stata 10.0. Resultados: Se analizaron 6.093 pacientes. Se encontró un cáncer en el 0,28 por ciento (17 pacientes) de los casos. 11 (64 por ciento) fueron carcinoides, 5 (29 por ciento) adenocarcinomas y 1 (6 por ciento) linfoma no Hodgkin. Edad promedio 23,45 (DS +/- 14,45) años en los carcinoidesy 65,75 (DS +/- 18,46) en los adenocarcmomas. En los carcinoides predominó el sexo femenino, contrario a lo sucedido en los adenocarcmomas. Se practicó cirugía curativa al 100 por ciento de los carcinoides y al 40 por ciento de los adenocarcinomas. Ubicación más frecuente: Carcinoides en tercio distal y adenocarcinoma en tercio proximal. Ningún tumor tuvo linfonodos comprometidos. 100 por ciento de sobrevida a 5 años en carcinoides. Conclusiones: El número de casos nuevos de cáncer en una apendicitis aguda es bajo. En los carcinoides, la sobrevida a 5 años es alta.

Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Adenocarcinoma/surgery , Appendectomy/statistics & numerical data , Appendiceal Neoplasms/surgery , Carcinoid Tumor/surgery , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Emergencies , Appendiceal Neoplasms/mortality , Appendiceal Neoplasms/pathology , Reoperation , Survival Analysis , Carcinoid Tumor/mortality , Carcinoid Tumor/pathology
Rev. chil. cir ; 62(3): 255-261, jun. 2010. tab, graf
Article in Spanish | LILACS | ID: lil-562725


Background: Malignant appendiceal tumors account for only 0.5 percent of all gastrointestinal tumors and there are usually diagnosed during the pathological study of excised appendices. Aim: To assess the factors influencing the survival of patients with appendiceal carcinomas. Material and Methods: Retrospective review of records of all primary appendiceal carcinomas diagnosed in the pathology unit of a regional hospital between 1993 and 2008. The surgical procedure, clinical history, morphological features of tumor and survival were recorded. Results: Eighty four patients aged 32 ± 15 years (44 women) with appendiceal carcinoma were identified. In 93 percent of patients, the clinical diagnosis was acute appendicitis. Sixty one patients (73 percent) had a carcinoid tumor, 20 (24 percent) an adenocarcinoma and three (3 percent), an adenocarcinoid tumor. Preoperative suspicion of a malignant tumor, level of tumor infiltration, pathological type, involvement of surgical borders, tumor size over 2 cm in the case of carcinoid tumors and the degree of differentiation of adenocarcinomas, had prognostic value. For adenocarcinomas, performing a right hemicolectomy significantly improved survival. Conclusions: Carcinoid tumors are the most common malignant tumor of the appendix. A right hemicolectomy may improve the survival of patients with appendiceal adenocarcinomas.

Introducción: Los tumores malignos del apéndice cecal representan tan sólo el 0,5 por ciento de todas las neoplasias gastrointestinales. Su diagnóstico generalmente no es sospechado por el clínico, siendo su diagnóstico un hallazgo durante el examen de la pieza operatoria. Algunos de estos tumores presentan buena supervivencia con la sola apendicetomía, aunque en ocasiones es necesario realizar tratamientos complementarios. El objetivo de este estudio es determinar la asociación entre variables clínicas y morfológicas con la supervivencia de pacientes con carcinomas del apéndice cecal y analizar el tratamiento quirúrgico realizado. Material y Método: Cohorte retrospectiva de 84 pacientes con carcinomas apendiculares diagnosticados en el Hospital Hernán Henríquez Aravena de Temuco entre los años 1993-2008. Se estudiaron variables clínico-morfológicas, el tratamiento quirúrgico realizado y la supervivencia para estos pacientes. Se utilizó estadística descriptiva y analítica, aplicando Chi-cuadrado y test exacto de Fisher para variables categóricas y T-Student para variables continuas; y prueba Log-rank (Mantel-Cox) para comparación de curvas de supervivencia con un IC de 95 por ciento. Resultados: Del total de apendicectomías (18.563) se verificaron 84 casos (0,45 por ciento); 48 por ciento hombres y 52 por ciento mujeres con una edad promedio de 31,9 +/- 15 años. En el 93 por ciento de los casos el diagnóstico clínico fue apendicitis aguda. Correspondieron a carcinoide, adenocarcinoma y adenocarcinoide en 61 (73 por ciento), 20 (24 por ciento) y 3 (3 por ciento) casos respectivamente. En el análisis bivariado las siguientes variables mostraron asociación pronóstica estadísticamente significativa: sospecha pre-operatoria (p = 0,009), nivel de infiltración tumoral (p = 0,04), tipo histológico (p = 0,009), compromiso de bordes quirúrgicos (p < 0,001), tamaño tumoral > 2 cm en tumores carcinoides (p = 0,001) y grado de diferenciación en adenocarcinomas...

Humans , Male , Female , Adolescent , Adult , Middle Aged , Adenocarcinoma/surgery , Adenocarcinoma/pathology , Carcinoma/surgery , Carcinoma/pathology , Appendiceal Neoplasms/surgery , Appendiceal Neoplasms/pathology , Appendectomy , Adenocarcinoma/mortality , Chi-Square Distribution , Carcinoma/mortality , Neoplasm Invasiveness , Appendiceal Neoplasms/mortality , Prognosis , Retrospective Studies , Survival Analysis
Rev. cuba. cir ; 47(4)sept.-dic. 2008.
Article in Spanish | LILACS, CUMED | ID: lil-515608


El objetivo de este trabajo fue dar a conocer un interesante caso de tumor carcinoide que se presentó con cuadro clínico de apendicitis aguda. El paciente fue un varón de 8 años de edad, al cual se realizó apendicectomía a causa de una apendicitis aguda. El resultado anatomopatológico confirmó un tumor de células endocrinas (argentafinoma, tumor carcinoide) en el tercio distal del órgano, que infiltraba hasta la serosa, y apendicitis aguda supurada. El paciente fue enviado a un servicio de oncohematología para tratamiento oncoespecífico. Por lo inusual de estos tumores en edades tempranas y por lo que puede representar para el niño una conducta no consecuente, decidimos presentar este caso a la comunidad científica nacional e internacional. Es extremadamente importante el seguimiento de los pacientes con apendicitis aguda y de las conclusiones del examen histológico, por lo que puede representar para el niño una conducta inadecuada en una situación como esta(AU)

The objective of this paper was to make known an interesting case of carcinoid tumor that presented a clinical picture of acute appendicitis.The patient was an eight-year-old boy that underwent appendectomy due to an acute appendicitis. The anatomopathological report confirmed an endocrine cell tumor (argentaffinoma, carcinoid tumor) in the distal third of the organ that infiltrated up to the serosa, and acute suppurative appendicitis. The patient was referred to an oncohematology service for oncospecific treatment. As it is a rare tumor at early ages, and taking into account what a inconsequent behavior may represent for the child, it was decided to present this case to the national and international scientific community. The follow-up of the patients with acute appendicitis and of the conclusions of the histological examination is extremely important considering what an inadequate conduct may represent for the child in a situation like this(AU)

Humans , Male , Child , Appendectomy/methods , Appendiceal Neoplasms/surgery , Carcinoid Tumor/surgery
Rev. argent. resid. cir ; 13(1): 33-35, abr. 2008.
Article in Spanish | LILACS | ID: lil-563183


Antecedentes: Los tumores apendiculares son una patología infrecuente. Representan el 0.5% de los tumores digestivos. Su diagnostico prequirúrgico es excepcional y constituye, generalmente un hallazgo incidental en el estudio anatomopatológico de la pieza quirúrgica. Objetivo: Evaluar la incidencia y tipo histológico de los tumores apendiculares, en apendicetomías realizadas en nuestra institución. Diseño: Retrospectivo, descriptivo. Material y Métodos: Se evaluaron retrospectivamente historias clínicas de pacientes apendicectomizados en un periodo de 10 años, año 1997 al 2007. Se excluyeron aquellas en las cuales no se había realizado estudio anatomopatológico. Se evaluaron 380 historias clínicas, estudiando aquellas con diagnostico de tumor apendicular maligno, registrando edad, sexo, clínica, tipo de tumor y tratamiento. Resultados: Se diagnosticaron 5 tumores malignos (1,3 %), 4 tumores carcinoides (1%), y 1 adenocarcinoma (0.3 %), 3 de sexo masculino (60 %) y 2 de sexo femenino (40%), con un promedio de edad de 41,6 años. La indicación quirúrgica fue por apendicitis en el 60 %. La sospecha intra-operatoria se planteo en 1 de los pacientes (20%). Conclusión: Los tumores apendiculares son neoplasias muy poco frecuentes, diagnosticadas generalmente en el estudio anatomopatológico, de allí la impor tancia del mismo. Estos tumores deben estar presentes en los diagnósticos diferenciales de la patología apendicular, su conocimiento permitirá realizar un tratamiento y manejo opor tuno del mismo.

Humans , Male , Female , Appendectomy , Diagnosis, Differential , Appendiceal Neoplasms/surgery , Appendiceal Neoplasms/diagnosis , Adenocarcinoma , Abdomen, Acute/surgery , Carcinoid Tumor
Rev. bras. colo-proctol ; 28(1): 89-94, jan.-mar. 2008. ilus
Article in Portuguese | LILACS | ID: lil-482437


INTRODUÇÃO: Mucocele do apêndice (MA) é uma lesão rara, caracterizada pelo acúmulo de secreção mucoíde em sua luz. Diagnóstico precoce é fundamental para evitar o extravasamento de secreção mucoíde na cavidade peritoneal, causando pseudomixoma peritoneal. RELATO DE CASO: Paciente sexo masculino, 62 anos com história de dor abdominal em fossa ilíaca direita há cerca de 6 meses. Realizou uma ultra-sonografia do abdome que evidenciou no flanco direito pequena estrutura cística compatível com MA. Colonoscopia, exames laboratoriais e dosagem do CEA encontravam-se sem alterações. O paciente foi submetido à laparotomia exploradora com ressecção do apêndice e do seu meso em monobloco. O exame histológico mostrou tratar-se de cistoadenoma do apêndice vermiforme. O paciente evoluiu sem intercorrências. DISCUSSÃO: A MA é um achado raro. As principais causas patológicas incluem cisto de retenção, mucocele secundária a epitélio hiperplásico, cistoadenomas e cistoadenocarcinomas. A doença é geralmente assintomática e o diagnóstico pré-operatório é raro. O tratamento para mucocele do apêndice é cirúrgico e a preocupação principal do cirurgião é evitar o extravasamento do conteúdo da mucocele na cavidade abdominal. CONCLUSÃO: A MA é uma entidade incomum e com alto potencial de complicação, usualmente curável com tratamento cirúrgico adequado.

INTRODUCTION: Appendiceal mucocele (AM) is a rare lesion that is characterized by an appendiceal lumen distended with mucus. Early diagnosis and prompt surgical intervention are mandatory to prevent spillage of the mucinous content into the peritoneal cavity, causing pseudomyxoma peritonei. CASE REPORT: A 62-year-old male was presented with a 6-months history of recurrent right lower quadrant abdominal pain. Ultrasonography showed a lesion in the right lumbar region compatible with AM. Colonoscopy, routine laboratory tests and CEA were normal. The patient underwent an appendectomy and complete excision of the cystic lesion. Pathologic examination revealed a mucinous cyst adenoma of appendix. The patient was symptom free after treatment. DISCUSSION: AM is a rare condtion. Mucoceles are histologically subdivided into retention mucocele, mucocele secondary a hiperpalsic epithelium, mucinous cystadenoma and mucinous cystadenocarcinoma. This disease is often asymptomatic and pre-operative diagnosis is rare. The treatment is essentially surgical and the surgeon need to avoid spillage of the mucinous content into the peritoneal cavity. CONCLUSION: AM is an uncomum entity and with high pontential of complication, usually curable with adequate surgical aproach.

Humans , Male , Middle Aged , Appendectomy , Appendix , Mucocele , Appendiceal Neoplasms/surgery , Appendiceal Neoplasms/diagnosis , Pseudomyxoma Peritonei
GED gastroenterol. endosc. dig ; 26(6): 204-206, nov.-dez. 2007. ilus
Article in Portuguese | LILACS | ID: lil-583684


Racional: O adenocarcinoma apendicular é enfermidade rara, geralmente identificada com um quadro clínico de apendicite aguda. O diagnóstico pré-operatório é extremamente difícil e incomum. Objetivo: Apresentar dois casos de adenocarcinoma apendicular, singulares por situar-se em faixa etária jovem, associado à revisão da literatura. Relato dos casos: Primeiro caso: Homem, 24 anos, submetido a apendicectomia por abdome agudo inflamatório. Encaminhado ao nosso serviço com diagnóstico anatomopatológico de adenocarcinoma mucinoso de apêndice. Realizados hemicolectomia direita, epiplectomia, esvaziamento ganglionar e resseção parcial de parede abdominal. Atualmente em quimioterapia. Segundo caso: Homem, 32 anos, no intraoperatório de apendicectomia, apresentou achado de lesão vegetante em ápice apendicular. O estudo anatomopatológico revelou presença de adenocarcinoma de apêndice. Realizada hemicolectomia direita com esvaziamento ganglionar. Atualmente, sem sinais de recidiva. Conclusão: A similaridade clínica e macroscópica entre o adenocarcinoma apendicular e a apendicite aguda, torna importante a checagem do exame anatomopatológico. Os casos relatados reforçam essa importância, por se tratar de indivíduos jovens, em que o diagnostico de adenocarcinoma foi confirmado pela patologia...

Humans , Male , Adult , Adenocarcinoma/surgery , Appendiceal Neoplasms/surgery , Appendectomy , Clinical Laboratory Techniques , Drug Therapy
Acta cir. bras ; 22(5): 407-411, Sept.-Oct. 2007. ilus
Article in English | LILACS | ID: lil-463468


Peritoneal pseudomyxoma is a pathological condition that compromises the peritoneum, characterized by the production of large quantities of mucinous liquid, which progressively fills the peritoneal cavity, originating in general from mucinous appendicular or ovarian tumors. We report a peritonial pseudomyxoma associated with mucinous adenocarcinoma of the appendix synchronic with adenocarcinoma of the rectum in 44 years old patient, where the initial diagnosis was rectal adenocarcinoma. Tumour of the appendix and peritonial pseudomyxoma were incidental and found intraoperativelly. We focus the histological patterns of the lesions, diagnosis and the treatment, with revision of the literature.

O pseudomixoma peritoneal é uma condição patológica que acomete o peritoneo, caracterizada pela produção de grandes quantidades de líquido mucinoso, que progressivamente preenche a cavidade peritoneal, tendo em geral como origem tumores mucinosos apendiculares ou de ovário. Relatamos a ocorrência de um pseudomixoma peritoneal associado a adenocarcinoma mucinoso do apêndice sincrônico e adenocarcinoma do reto em paciente de 44 anos, cujo diagnóstico inicial foi de adenocarcinoma do reto. A neoplasia do apêndice e o pseudomixoma peritonial foram achados incidentais, intra-operatórios. Enfocamos as principais características anatomo-patológicas das lesões, o diagnóstico e tratamento, através de ampla revisão da literatura.

Adult , Humans , Male , Adenocarcinoma, Mucinous/diagnosis , Appendiceal Neoplasms/diagnosis , Neoplasms, Multiple Primary/diagnosis , Pseudomyxoma Peritonei/diagnosis , Rectal Neoplasms/surgery , Adenocarcinoma, Mucinous/surgery , Appendiceal Neoplasms/surgery , Incidental Findings , Neoplasms, Multiple Primary/surgery , Pseudomyxoma Peritonei/surgery , Rectal Neoplasms/diagnosis