Malignant transformation of abdominal wall endometriosis to clear cell carcinoma: case report

ABSTRACT BACKGROUND: Malignant transformation of endometriosis in the abdominal wall is a rare and still poorly understood event. Less than 30 cases have been reported in the worldwide literature. Most cases of solid tumors are report in a previous abdominal scar with malignant transformation of a focus of endometriosis. Presence of lymph node metastases in nearby chains is frequent and is associated with poor prognosis. CASE REPORT: We report a case of a 42-year-old woman with a history of abdominal surgery (Pfannenstiel) to resect abdominal wall endometriosis. Physical examination revealed a solid mass of approximately 10 cm x 6 cm in the anterior wall of the abdomen. Computed tomography (CT) of the abdomen and pelvis showed a heterogeneous, predominantly hypoattenuating expansive formation measuring 10.6 cm x 4.7 cm x 8.3 cm. The patient underwent exploratory incisional laparotomy, block resection of the abdominal mass and lymphadenectomy of the external and inguinal iliac chains. The abdominal wall was reconstructed using a semi-absorbable tissue-separating screen to reconstitute the defect caused by resection of the tumor. Histological evaluation revealed infiltration by malignant epithelioid neoplasia, thus confirming the immunohistochemical profile of adenocarcinoma with clear cell components. Lymphadenectomy showed metastatic involvement of an external iliac chain lymph node. CONCLUSION: Resection of the mass along with the abdominal wall, with wall margins, is the most effective treatment. Reconstruction is a challenge for surgeons. The patient has been followed up postoperatively for eight months, without any evidence of disease to date.

Tratamento não cirúrgico bem sucedido de pneumoretroperitônio causado por CPRE / Successful nonsurgical treatment of pneumoretroperitoneum following ERCP

Complicações relacionadas à colangiopancreatografia retrógrada endoscópica (CPRE) incluem pancreatite, hemorragia, colangite e perfuração. A perfuração relacionada à CPRE é infrequente, entretanto apresenta taxas de mortalidades elevadas. O diagnóstico requer um alto grau de suspeição clínica para a detecção precoce para permitir o tratamento adequado da perfuração e melhor prognóstico. O tratamento depende da localização e mecanismo da perfuração. Relatamos um caso de tratamento não operatório de um paciente com extenso retropneumoperitônio após perfuração por CPRE.

Complications related to endoscopic retrograde cholangiopancreatography (ERCP) include pancreatitis, hemorrhage, cholangitis, and perforation. ERCP-related perforation is uncommon, but mortality rates are high. Diagnosis requires a high clinical suspicion for early detection to allow optimalmanagement of the perforation and a better prognosis. Treatment depends on the location and mechanism and increasingly involves nonoperative management. We report a case of successful nonsurgical treatment of a patient with extensive air involving the peritoneum, retroperitoneum, thorax, mediastinum, and subcutaneous tissues following an ERCP perforation.

Avaliação da qualidade de vida dos doentes com adenocarcinoma do reto distal tratados com rádio e quimioterapia como primeira abordagem e submetidos a diferentes condutas terapêuticas / Assessment of quality of life in patients with distal rectal adenocarcinoma treated by radiochemoterapy as first approach and undergoing different terapeutics

O estudo avaliou a qualidade de vida (QOL) de 52 doentes com carcinoma do reto distal submetidos à rádio e quimioterapia (RT/QT) como primeira abordagem e submetidos as seguintes terapêuticas: 23 não foram operados (NO), 17 submetidos à amputação do reto(AR) e 12 à ressecção anterior(RA). A idade variou de 35 a 85 anos, sendo 30 homens e 22 mulheres. O seguimento foi de 36 a 129 meses. Aplicaram-se os questionários da EORTC (QLQ-C30 e QLQ-CR38), no período de janeiro a junho de 2002. Os NO apresentaram melhores índices de QOL geral, aspecto social e imagem corporal comparados com os operados. Quanto aos com AR e os com RA não apresentaram diferença da QOL / This study assessment the quality of life of 52 patients with distal rectal adenocarcinomas treated by radiochemotherapy as first approach and undergoing different therapeutics, 23 were not operated (NO), abdominoperineal was performed in 17, low anterior resection in 12. The age range from 35 to 85 years, 30 men, 22 women, the follow-up range from 36 to 129 months. QOL was assessed using the EORTC questionnaires (QLQ-C30 , QLQ-CR38), from January to June of 2002. The NO had a better QOL, social function and body image than the operated group, however, between the two surgical groups no differences were observed. The acute adverse effects of radiochemotherapy did not affect the QOL. The associated diseases even cause worst physical function and a higher symptoms of pain, dyspnoea and fatigue, did not compromised the QOL...