Adenoma hepatocelular con captación de 18 flúor deoxiglucosa en PET-TC SCAN. Una "mini-review" e informe de un nuevo caso / 18-fluoro-deoxyglucose uptake on PET-CT in hepatocellular adenoma. A mini review with a new case Report

RESUMEN La captación de 18 FDG en PET-TC por un adenoma hepatocelular (HCA) es poco frecuente. Esta situación genera dudas en cuanto a los diagnósticos diferenciales y tratamiento. El objetivo de este artículo fue realizar una mini revisión de los últimos 37 años de HCA con avidez por el 18FDG y presentar un nuevo caso. Sobre la base de un estudio realizado por otros autores entre 1984 y 2014, se amplía la búsqueda utilizando las mismas palabras clave hasta el año 2021. Se analizan los datos relevantes. Entre 1984 y 2021 detectamos 38 casos en 37 años. Fue más frecuente en mujeres en edad reproductiva. Los subtipos H-HCA e I-HCA fueron los más frecuentes. El tratamiento quirúrgico fue el más empleado. La diferenciación celular y los trastornos metabólicos de la glucosa y de los lípidos favorecerían la captación de 18FDG. La resección hepática ofrecería mayores garantías permitiendo el estudio completo de la lesión.

ABSTRACT Hepatocellular adenoma (HCA) uptake of 18FDG uptake on PET-CT is rare. This situation poses doubts about the differential diagnoses and treatment. The aim of this article is to perform a mini review of 18FDG avid HCA over the past 37 years and to describe a new case presentation. Based on a study conducted by other authors between 1984 and 2014, we extended the search until 2021 using the same keywords. The relevant data were analyzed. Between 1984 and 2021 we detected 38 cases in 37 years. HCAs were more common in women of childbearing age. The most common types were H-HCA an I-HCA. Surgical resection was the treatment most used. Cell differentiation and glucose and lipid metabolic diseases would favor 18FDG uptake. Liver resection provides better outcomes, allowing for a complete examination of the lesion.

Validez del hallazgo de nódulos en la colonoscopia para el diagnóstico de hiperplasia nodular linfoide en niños / Validity of nodules detected at colonoscopy for the diagnosis of nodular lymphoid hyperplasia in children

Resumen Introducción: la hiperplasia nodular linfoide del colon se define como > 10 nódulos linfoides visibles en colonoscopia. No existen estudios de su validez al compararlo con la histopatología. Objetivos: determinar la validez del hallazgo de nódulos en colonoscopia para el diagnóstico de hiperplasia nodular linfoide. Material y métodos: estudio prospectivo de prueba diagnóstica. Se incluyeron colonoscopias realizadas consecutivamente de 2014 al 2018 con equipos Olympus PCFQ150AI y GIFXP150N con obtención de biopsias. El criterio endoscópico fue la presencia de > 10 nódulos de 2 a 10 mm y el criterio histológico fue hiperplasia de folículos linfoides y mantos de linfocitos en lámina propia o submucosa. Los datos se analizaron en Epidat3.1. Se obtuvo la sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y negativo (VPN), y coeficientes de probabilidad positivo (LR+) y negativo (LR-) con sus intervalos de confianza. Resultados: se incluyeron 327 colonoscopias, la mediana de edad fue de 84 meses. La principal indicación para la colonoscopia fue sangrado digestivo bajo (38,8%). El hallazgo de nódulos se encontró en el 21% y el sitio de mayor frecuencia fue el colon total (46%), mientras que por histopatología se encontró hiperplasia nodular linfoide en el 38%. El hallazgo de nódulos obtuvo una S de 32% (intervalo de confianza [IC] del 95%: 24-140), E de 84% (IC 95%: 79-89), VPP de 56% (IC 95%: 44-68), VPN de 67% (IC 95%: 61-72), LR+ de 2,04 (IC 95%: 1,4-3) y LR- de 0,8 (IC 95%: 0,8-0,9). Conclusiones: la validez diagnóstica del hallazgo de nódulos en colonoscopia para hiperplasia nodular linfoide es pobre, por lo que la toma de biopsia debe recomendarse siempre.

Abstract Introduction: Nodular lymphoid hyperplasia of the colon is characterized by the presence of >10 lymphoid nodules visible in colonoscopy. There are no studies that confirm their validity when compared with histopathology. Objective: To determine the validity of nodules detected at colonoscopy for the diagnosis of nodular lymphoid hyperplasia in children. Materials and methods: Prospective study of diagnostic test accuracy. Colonoscopies performed consecutively from 2014 to 2018 using Olympus PCFQ150AI and GIFXP150N biopsy machines were included. The endoscopic criterion was the presence of >10 nodules from 2 to 10mm of diameter, while the histological criterion was presence of follicular lymphoid hyperplasia and lymphocyte mantles in lamina propia or submucosa. Data were analyzed in Epidat3.1. Sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were obtained with their corresponding confidence intervals. Results: 327 colonoscopies were included; the median age was 84 months. The main indication for colonoscopy was lower gastrointestinal bleeding (38.8%). Nodules were found in 21% of the patients, predominantly throughout the whole colon (46%), whereas histopathology found nodular lymphoid hyperplasia in 38%. SE for the finding of nodules was 32% (95% confidence interval [CI]: 24-140), SP was 84% (95% CI: 79-89), PPV was 56% (95% CI: 44-68), NPV was 67% (95% CI: 61-72), LR+ was 2.04 (95% CI: 1.4-3) and LR- was 0.8 (95% CI: 0.8-0.9). Conclusions: The validity of the presence of nodules on colonoscopy for the diagnosis of nodular lymphoid hyperplasia is poor, so biopsy should always be performed.

Ressecção laparoscópica de tumores benignos do fígado: posição atual / Laparoscopic liver resection for benign tumors: the current position

RESUMO - RACIONAL: As principais indicações das hepatectomias video-laparoscópicas (HVL), inicialmente, eram nas lesões hepáticas benignas. À medida que a HVL se tornou mais popular, as indicações de doenças malignas superaram as de doenças benignas. Este estudo teve como objetivo discutir as indicações e resultados da HVL para o tratamento de tumores hepáticos benignos. MÉTODOS: De 445 HVL realizadas em um único centro, 100 (22,4%) foram para tumores benignos. Os autores discutem as indicações para ressecção e apresentam seus resultados perioperatórios. RESULTADOS: No total, 100 pacientes com tumores benignos foram avaliados, a saber: 66 casos de adenomas hepatocelulares; 14 de neoplasia mucinosa biliar; 13 de hiperplasia nodular focal; 4 de angiomiolipomas; e 3 de hemangiomas. O tamanho médio das lesões foi de 7,6 cm (3,1 a 19,6 cm). A taxa de morbidade total foi de 19%, sendo 9% classificados como Clavien-Dindo 3 ou 4 e não foi observada mortalidade. CONCLUSÃO: A HVL para tumores hepáticos benignos é segura e apresenta excelentes resultados. No entanto, as indicações para cirurgia são cada vez mais restritas, não sendo recomendável indicar a ressecção somente por se tratar de procedimento minimamente invasivo.

ABSTRACT - BACKGROUND: The main indications of the use of laparoscopic liver surgery (LLS), in the early days, were benign liver lesions. As LLS became more popular, indications for malignant diseases outnumbered those for benign ones. This study aims to rule out the indications and results of LLS for the treatment of benign liver tumors. METHODS: Out of 445 LLS performed in a single center, 100 (22.4%) were for benign tumors. The authors discuss the indications for resection and present their perioperative results. RESULTS: In total, 100 patients with benign tumors were evaluated. Specifically, these were as follows: 66 cases of hepatocellular adenomas; 14 cases of biliary mucinous neoplasm; 13 cases of focal nodular hyperplasia; 4 cases of angiomyolipomas; and 3 cases of hemangiomas with a mean size of 7.6 cm (ranging from 3.1 to 19.6 cm). The total morbidity rate was 19%, with 9% classified as Clavien-Dindo grades 3 or 4. No mortality was observed. CONCLUSION: LLS for benign liver tumors is safe and presents excellent results. However, indications for resection are increasingly restricted and should not be performed just because it is a minimally invasive procedure.

Seguimiento de un caso de hiperplasia nodular focal hepática por resonancia magnética con medio de contraste hepatoespecífico / Monitoring of a hydroplasia nodular focal hepatic case for magnetic resonance with hepato-specific contrast medium

La hiperplasia nodular focal (HNF) es el tumor hepático benigno más frecuente después del hemangioma, producto de una respuesta hiperplásica a una anomalía vascular focalizada. A menudo asintomática, la mayor parte de las ocasiones es descubierta incidentalmente. Se presenta más frecuente en mujeres jóvenes de mediana edad con antecedente de ingesta prolongada de anticonceptivos orales. Este tipo de neoformación tiene hallazgos característicos en los diferentes métodos por imágenes. Normalmente tienden a permanecer de las mismas dimensiones e incluso involucionan durante un largo periodo bajo observación. Se presenta el caso de una paciente de 46 años que consultó en SOLCA, Guayaquil, en el año 2016, por un tumor hepático detectado por estudio ecográfico particular, luego de lo cual se le realiza estudios por ultrasonido y tomografía computada en los cuales se evidencia proceso neoformativo en segmento VI hepático. Ante la naturaleza de la lesión, se decide valorarla por medio de resonancia magnética (RM) de abdomen con medio de contraste hepatoespecífico, donde se identifica lesión que por sus características y comportamiento, se plantea como primera posibilidad diagnóstica hiperplasia nodular focal, patología de carácter benigno. Al presentar exámenes de laboratorio sin alteraciones y marcadores tumorales negativos, se optó como conducta terapéutica realizar observación y seguimiento de la paciente a través del mismo método de imágenes sin tratamiento farmacológico. En estudio control por ecografía un año después la lesión permanece sin cambios, manteniéndose la conducta expectante hasta el presente año, en el que se realiza RM, sin evidencia de cambios en su morfología y comportamiento, diferenciándola de otro tipo de lesiones hepáticas y de esta manera se evita procedimientos invasivos como la biopsia. La lesión al permanecer sin cambios, demuestra que la conducta ante una paciente con HNF debe ser expectante, por el potencial que posee esta lesión de sufrir una regresión espontánea.

Method: Focal nodular hyperplasia (FNH) is the most frequent benign liver tumor after hemangioma, it is caused by the hyperplastic response to a focal vascular anomaly. Most of the time asymptomatic is discovered incidentally. It occurs more frequently in young middle-aged women with a history of prolonged oral contraceptive intake. This type of neoformation has characteristic findings in different imaging methods. They usually tend to remain the same size and even involute for a long period under observation. We present the case of a patient with FNH, the diagnosis and monitoring was performed by magnetic resonance with hepatospecific contrast, it is a technique that allows observing its benign behavior, differentiating it from other types of liver lesions and avoids invasive procedures such as biopsy. After 2 years of diagnosis, the lesion remains without changes, demonstrating that the attitude towards a patient with FNH should be observant, since they have the potential for the spontaneous regression.

Hiperplasia linfoide ileo-colónica en pacientes pediátricos / Ileo-colonic lymphoid hyperplasia in pediatric patients

Introducción: La Hiperplasia nodular linfoide gastrointestinal constituye una entidad infrecuente con manifestaciones clínicas diversas y con mayor frecuencia en la edad pediátrica. Objetivo: Caracterizar clínica, endoscópica e histológicamente a los pacientes pediátricos con hiperplasia linfoide de colon e íleon terminal diagnosticados en el Instituto de Gastroenterología. Material y Métodos: Se realizó un estudio descriptivo, transversal, en el periodo comprendido entre 2014 y 2016 en el Instituto de Gastroenterología. La muestra estuvo constituida por 50 pacientes, quienes cumplieron los criterios de inclusión y exclusión. Se evaluaron variables demográficas, clínicas, endoscópicas e histológicas, así como el comportamiento de la comorbilidad con enfermedades malignas, enfermedades inflamatorias intestinales, giardiosis, trastornos de la respuesta inmunohumoral y alergias alimentarias. Resultados: El sexo masculino, entre 7-10 años y el color de la piel blanca fueron los más frecuentes. El sangrado rectal fue el síntoma principal (62 por ciento) y la localización a nivel del íleon terminal en 69 por ciento, no se relacionó con enfermedad maligna, hubo tres pacientes con diagnóstico de hiperplasia linfoide de íleon terminal y colitis ulcerosa. El 74 por ciento presentó aspecto nodular por histología y 60 por ciento se le diagnosticó Giardia lamblia, en la evaluación inmunohumoral predominó los pacientes sin inmunocompromiso (78 por ciento), el Prick Test fue positivo en 60 por ciento, sobre todo, a la leche de vaca. Conclusiones: La manifestación clínica que predominó fue el sangrado rectal, endoscópicamente la localización en íleon y la forma nodular por histología. No encontramos comorbilidades con enfermedades malignas y fueron más frecuentes los trastornos alérgicos y parasitarios que las alteraciones inmunológicas(AU)

Introduction: Lymphoid nodular hyperplasia of the gastrointestinal tract is an uncommon entity with diverse clinical manifestations, which is more frequent in the pediatric age. Objective: To characterize clinically, endoscopically, and histologically, those pediatric patients with lymphoid hyperplasia of the colon and terminal ileum diagnosed in the Institute of Gastroenterology. Material and Methods: A descriptive, cross-sectional study was carried out during the period between 2014 and 2016 in the Institute of Gastroenterology. The sample consisted of 50 patients who met the inclusion and exclusion criteria. Demographic, clinical, endoscopic and histological variables were evaluated, as well as the behavior of comorbidity with malignant diseases, inflammatory bowel diseases, giardiasis, disorders of the humoral immune response and food allergies. Results: The male sex, the age group between 7-10 years, and the white skin color were the most frequent. Rectal bleeding was the main symptom (62 percent), and the location of the lesions in the terminal ileum was observed in 69 percent of the patients. There was no relationship between lymphoid hyperplasia and malignant disease, but three patients were diagnosed with lymphoid hyperplasia of the terminal ileum, and ulcerative colitis. 74 percent of the biopsies presented a nodular variety, and 60 percent of the patients were diagnosed with Giardia lamblia; the cases that were not immunocompromised prevailed in the evaluation of humoral immune response (78 percent); the Prick Test was positive in 60 percent of children, especially to cow's milk. Conclusions: The predominant clinical manifestation was rectal bleeding; the localization was in the ileum, which was seen by endoscopic procedure; and the nodular form was demonstrated by histology. We did not find comorbidities with malignant diseases, and allergic and parasitic disorders were more frequently diagnosed than immunological alterations(AU)

Tuberculoma hepático que simula metástasis de carcinoma neuroendocrino gástrico / Hepatic tuberculoma simulating metastasis of gastric neuroendocrine carcinoma

La tuberculosis es una de las enfermedades infecciosas más frecuentes de distribución mundial, con una amplia presentación clínica. La afectación hepática de la tuberculosis es poco frecuente, pero más infrecuente aún lo es el tuberculoma hepático. Se presenta el caso de una paciente con tuberculoma hepático solitario que simula metástasis hepática secundaria a tumor neuroendocrino

Tuberculosis is one of the most common infectious diseases, with worldwide distribution and ample clinical manifestations. Hepatic tuberculosis is rare but hepatic tuberculoma is even rarer. We report an unusual case of a solitary hepatic tuberculoma simulating hepatic metastasis of a neuroendocrine tumor

Hypervascular liver lesions in radiologically normal liver / Lesão hepática hipervascular em fígado radiologicamente normal

ABSTRACT Background: The hypervascular liver lesions represent a diagnostic challenge. Aim: To identify risk factors for cancer in patients with non-hemangiomatous hypervascular hepatic lesions in radiologically normal liver. Method: This prospective study included patients with hypervascular liver lesions in radiologically normal liver. The diagnosis was made by biopsy or was presumed on the basis of radiologic stability in follow-up period of one year. Cirrhosis or patients with typical imaging characteristics of haemangioma were excluded. Results: Eighty-eight patients were included. The average age was 42.4. The lesions were unique and were between 2-5 cm in size in most cases. Liver biopsy was performed in approximately 1/3 of cases. The lesions were benign or most likely benign in 81.8%, while cancer was diagnosed in 12.5% of cases. Univariate analysis showed that age >45 years (p< 0.001), personal history of cancer (p=0.020), presence of >3 nodules (p=0.003) and elevated alkaline phosphatase (p=0.013) were significant risk factors for cancer. Conclusion: It is safe to observe hypervascular liver lesions in normal liver in patients up to 45 years, normal alanine aminotransaminase, up to three nodules and no personal history of cancer. Lesion biopsies are safe in patients with atypical lesions and define the treatment to be established for most of these patients.

RESUMO Racional: As lesões hepáticas hipervasculares representam um desafio diagnóstico. Objetivo: Identificar fatores de risco para câncer em pacientes portadores de lesão hepática hipervascular não-hemangiomatosa em fígado radiologicamente normal. Método: Estudo prospectivo que incluiu pacientes com lesões hepáticas hipervasculares em que o diagnóstico final foi obtido por exame anatomopatológico ou, presumido a partir de seguimento mínimo de um ano. Diagnóstico prévio de cirrose ou radiológico de hemangioma foram considerados critérios de exclusão. Resultados: Oitenta e oito pacientes foram incluídos. A relação mulher/homem foi de 5,3/1. A idade média foi de 42,4 anos. Na maior parte das vezes as lesões hepáticas foram únicas e com tamanho entre 2-5 cm. Em aproximadamente 1/3 dos casos foi realizada biópsia hepática. Em 81,8% dos casos as lesões eram benignas ou provavelmente benignas enquanto que em 12,5% dos casos o diagnóstico foi de câncer. A análise univariada mostrou que idade superior a 45 anos (p<0,001), antecedente familiar pessoal de câncer (p=0,020), presença de mais de três nódulos (p=0,003) e elevação da alanina aminotransaminase (p=0,013) foram fatores de risco relevantes para o câncer. Conclusões: È indicado observar lesões hepáticas hipervasculares em fígado normal em pacientes com até 45 anos, alanina aminotransaminase normal, com até três nódulos e sem antecedente pessoal de câncer. Para os demais com lesões atípicas, a biópsia da lesão é segura e define na maior parte dos pacientes o tratamento a ser instituído.

Hiperplasia nodular linfoide asociada con colitis ulcerativa: descripción de un caso y revisión de la literatura / Lymphoid Nodular Hyperplasia Associated with Ulcerative Colitis: Case Study and Literature Review

La hiperplasia nodular linfoide es una patología del aparato gastrointestinal, poco frecuente en adultos. Se caracteriza por un crecimiento del tejido linfoide mucoso y submucoso como respuesta a diferentes tipos de estímulos nocivos. Se ha descrito asociada con otras patologías como infección por VIH/ Síndrome de Inmunodeficiencia Adquirida, giardiasis, infección por Helicobacter Pylori, enfermedad celíaca, y en pocos casos con enfermedad inflamatoria intestinal. No tiene una presentación clínica específica y su manejo aún no está claro

Lymphoid nodular hyperplasia is a pathology of the gastrointestinal tract that rarely occurs among adults. It is characterized by growth of submucosal lymphoid tissue and mucosal response to different types of noxious stimuli. It has been described in association with other diseases such as HIV/AIDS, giardiasis, Helicobacter pylori infections, celiac disease, and very rarely with inflammatory bowel disease. At present, there is no specific clinical presentation or treatment

Diagnosis and treatment of benign liver nodules: Brazilian Society of Hepatology (SBH) recommendations

ABSTRACT Space-occupying lessions of the liver may be cystic or solid. Ultrasonography is an extremely useful method for initial screening, and suffices for diagnosis of simple hepatic cysts. Complex cysts and solid masses require computed tomography or magnetic resonance imaging for confirmation. Wide surgical excision is indicated in cystadenoma or cystadenocarcinoma. Clinical and epidemiological data are important, as nodules in noncirrhotic livers are more likely to be benign. Hemangiomas, the most common benign tumors, require no follow-up after diagnostic confirmation if they are small and asymptomatic. Patients with giant, symptomatic hemangiomas or compression of adjacent structures should be referred to hepatobiliary centers for potential surgery. The genetic heterogeneity of hepatocellular adenoms and their epidemiology and prognosis prompted classification of these tumors into four subtypes based on histology and immunohistochemistry. The major complications of hepatocellular adenoms are rupture with bleeding and malignant transformation. Rupture occurs in approximately 30% of cases. The main risk factors are tumors size >5 cm and inflammatory subtype. Hepatocellular adenoms may enlarge during pregnancy due to marked hormonal stimulation. As oral contraceptive pills and anabolic steroids have associated with hepatocellular adenoms growth, particularly of the hepatocyte nuclear factor-1 alfa subtype, these drugs should be discontinued. Focal nodular hyperplasia is the second most common benign tumor of hte liver. It is most frequent in women aged 20 to 60, and 70% to 90% of cases are asymptomatic. In the adsence of a central scar and/or other hallmarks of Focal nodular hyperplasia, with uncertainty between this diagnosis and hepatocellular adenoma, liver-specific contrast agentes are indicated.

RESUMO As lesões que ocupam espaço no fígado podem ser císticas ou sólidas. A ultrassonografia é extremamente útil como rastreamento inicial, bastando como método diagnósticos em casos de cistos simples. Em cistos complexos e em nódulos sólidos é necessária a complementação diagnóstica com tomografia computadorizada ou ressonância magnética. Em casos de cistadenoma ou cistadenocarcinoma, a ampla retirada cirúrgica está indicada. Dados clínico-epidemiológicos são importantes, já que nódulos em fígados não-cirróticos têm maiores probabilidades de serem benignos. Para os hemangiomas, tumores benignos mais frequentes, após a confirmação diagnóstica não existe necessidade de acompanhamento sistemático quando os nódulos são pequenos e assintomáticos. Hemangiomas gigantes sintomáticos ou comprimindo órgãos vizinhos devem ser encaminhados a centros de referência para avaliação de intervenção cirúrgica. A heterogeneidade genética nos adenomas hepatocelulares bem como características epidemiológicas e prognósticas motivou sua classificação em quatro subtipos, com base em achados histológicos e de imunohistoquímica. As principais complicações que ocorrem com o adenomas hepatocelulares são ruptura com hemorragia e transformação carcinomatosa. A primeira ocorre em cerca de 30% dos casos e o principal fator de risco para esta complicação são tumores maiores do que 5 cm, do subtipo hiperplasia nodular focal 1A, esses medicamentos devem ser suspensos. A hiperplasia nodular focal é o segundo tumor benigno mais frequente, mais comum nas mulheres entre 20 e 60 anos, sendo assintomáticos em 70% a 90% dos casos. Na ausência de lesão cicatricial central e/ou outros sinais sugestivos de hiperplasi nodular focal, havendo dúvida diagnóstica com adenoma hepatocelular, o uso de contraste hepatespecíficos está indicado.

Neoplasias hepáticas benignas: variantes histológicas, problemas diagnósticos y diagnóstico diferencial / Diagnosis and Differential Diagnosis Problems with Histological Variants of Benign Liver Neoplasms

Un principio básico de la patología es que las neoplasias se diferencian según sus células de origen y en el hígado semejan sus constituyentes, sean las células hepáticas, del epitelio biliar, endoteliales, mesenquimales o una combinación de estas. Es importante recordar aquí que son las metástasis el tumor maligno más frecuente del hígado, con una relación de 30:1 en pacientes sin enfermedad hepática crónica o cirrosis subyacente; es rara la presencia de las mismas en hígados cirróticos. Las neoplasias gastrointestinales del colon, páncreas, vía biliar extrahepática, estómago, tumores neuroendocrinos y GIST, o extraintestinales del pulmón, mama, melanoma o tumores de cabeza y cuello, son las más frecuentes (1). En este artículo solo revisaremos las más frecuentes. Iniciaremos con las neoplasias benignas y las lesiones pseudotumorales haciendo especial énfasis en aquellas con dificultades diagnósticas, en la utilidad de estudios especiales de inmunohistoquímica o moleculares para su adecuada clasificación y diagnóstico diferencial.

A basic principle of pathology is that neoplasms differ according to their cells of origin. Neoplasms of the liver resemble its constituent liver, biliary, epithelial, endothelial, mesenchymal cells or some combination of these different types of cells. It is important to remember here that metastases are the most frequent malignant liver tumor occurring at ratio of 30: 1 in patients without underlying chronic liver disease or cirrhosis. Metastases are rare in cirrhotic livers. The most common primary sites are the colon, pancreas, common bile duct, stomach, neuroendocrine tumors and GIST, or extraintestinal tumors from the lung, breast, head, neck and skin (1). In this article we review only the most frequent benign neoplasms and tumor-like lesions with particular emphasis on diagnostic difficulties, special studies, and the usefulness of immunohistochemical or molecular studies for proper classification and differential diagnosis.

Hiperplasia de las glándulas de Brunner: A propósito de 2 casos / Brunners gland hiperplasia: Report of two cases

La hiperplasia de las glándulas de Brunner constituye una lesión benigna infrecuente localizada en la primera o segunda porción duodenal. El espectro de la misma incluye la hiperplasia nodular circunscrita, la difusa y los adenomas de las glándulas de Brunner. Reportamos dos casos, uno con un adenoma de las glándulas de Brunner como un pólipo duodenal y el otro como una hiperplasia nodular difusa del bulbo duodenal.

Brunner’s gland hyperplasia is an infrequent benign injury located on the first or second portion of the duodenum. The disease spectrum includes diffuse nodular hyperplasia, circumscribed nodular hyperplasia, and Brunner’s gland adenoma. We report two cases, one with an adenoma of Brunner’s glands as a duodenal polyp and the other as a diffuse nodular hyperplasia of the duodenal bulb.

Hiperplasia nodular regenerativa del hígado secundaria a uso de azatioprina por trasplante renal previo, tratado con trasplante combinado hepático y renal / Combined hepatic and renal transplant after nodular regenerative hyperplasia of the liver secondary to azathioprine in renal transplant patient

Nodular regenerative hyperplasia is an uncommon condition, characterized by the presence of regenerative nodules with minimal or absence of fibrosis, which can lead to non-cirrhotic portal hypertension. There are numerous diseases, conditions and drugs that can cause it. Thiopurines, a group of immunosuppressors used in transplanted patients, has been linked to this entity. We report a case of a renal transplant woman, who has been on chronic therapy with azathioprine and that develops portal hypertension and end-stage renal disease, undergoing combined hepatic and renal transplant. Histological examination of the explanted liver was compatible with nodular regenerative hyperplasia. How azathioprine causes this entity is unknown, but endothelial vascular damage in a dose-dependent manner is postulated as the main mechanism. To our knowledge, this is the first case report of a renal transplant patient who develops nodular regenerative hyperplasia of the liver in association with azathioprine, and undergoes combined hepatic and renal transplant, with a favorable outcome 5 years post procedure.

La hiperplasia nodular regenerativa es una entidad infrecuente, que se caracteriza por la presencia de nódulos hepáticos con ausencia o mínima fibrosis y que puede llevar a hipertensión portal de origen no cirrótico. Existen diversas enfermedades, condiciones y medicamentos que la causan, destacando entre estos últimos las tiopurinas, inmunosupresores utilizados habitualmente en trasplantados. Se presenta el caso de una paciente trasplantada renal usuaria crónica de azatioprina, que desarrolla hipertensión portal además de deterioro de la función renal, requiriendo de un doble trasplante hepático y renal, destacando en la biopsia del explante hallazgos histológicos compatibles con hiperplasia nodular regenerativa. Los mecanismos de daño por azatioprina en esta entidad son desconocidos, pero se postula al daño endotelial dosis-dependiente como principal causa. La revisión de la literatura demuestra que este caso corresponde al primero de hiperplasia nodular regenerativa secundaria a azatioprina en trasplantado renal, que requiere de doble trasplante hepático y renal con evolución favorable hasta 5 años post trasplante.

Síndrome hepatopulmonar en paciente con hipertensión portal no cirrótica. Reporte de caso / Case report of hepatopulmonary syndrome in patients with non-cirrhotic portal hypertension

Presentamos el caso de una paciente con diagnóstico de síndrome hepatopulmonar (SHP) secundario a hipertensión portal no cirrótica subyacente, en el contexto de trombosis crónica de la vena porta y la mesentérica, por trombofilia primaria (deficiencia de proteína C-S). Se hizo el diagnóstico de SHP al encontrar una ecocardiografía contrastada con solución salina agitada positiva para un shunt extracardíaco, una gammagrafía con macroagregados de albúmina con evidencia de captación a nivel cerebral e hipoxemia persistente con gradiente alvéolo-arterial elevado para la edad de la paciente.

We report the case of a female patient diagnosed with hepatopulmonary syndrome (HPS) which occurred in the context of chronic thrombosis of the portal and mesenteric veins resulting from primary thrombophilia (protein C and protein S deficiencies). This case of HPS was diagnosed when echocardiography with agitated saline contrast showed the patient was positive for extra cardiac shunt. Scintigraphy using albumin macro-aggregates showed evidence of uptake in the brain and persistent hypoxemia with elevated alveolar-arterial gradient for the age of the patient.

Hiperplasia nodular da glândula de Bartholin: relato de casos e revisão da literatura / Nodular hyperplasia of Bartholin's gland: case reports and literature review

The Bartholin's gland (BG) may develop several tumoral lesions such as BG duct cysts, carcinomas, hyperplasias, and adenomas. BG nodular hyperplasias (NHs) are uncommon, and few cases have been reported in the literature. Specific criteria for the distinction between adenomas and hyperplasias have been recently established. Several questions on possible etiologies and appropriate medical approach still remain. Therefore, this work comprises three case reports of NH and an extensive literature review.

A glândula de Bartholin (GB) pode ser sede de várias lesões tumorais, como cistos do ducto da GB, carcinomas, hiperplasias e adenomas. A hiperplasia nodular (HN) da GB é uma lesão rara e poucos casos foram relatados na literatura. Recentemente, critérios específicos estabeleceram a diferenciação entre adenomas e hiperplasias. Muitas dúvidas ainda permanecem sobre as possíveis etiologias e a conduta ideal ante essa lesão. Diante disso, o presente trabalho realizou o relato de três casos de HN e ampla revisão sobre o tema.

Aporte del SPECT-CT en la detección y localización de hiperplasia nodular focal del hígado / Usefulness of SPECT-CT in detection and location of focal nodular hyperplasia

Se presenta el caso clínico de una mujer de 39 años de edad que consulta por dolor abdominal. Los hallazgos en el Ultrasonido efectuado con Doppler y la Resonancia Magnética dinámica no lograron establecer el diagnóstico diferencial entre adenoma e hiperplasia nodular focal. Se complementó el estudio con una cintigrafía de vía biliar detectándose en controles tardíos dos focos de retención del radiofármaco. El estudio tomográfico del hígado con Tc99m-coloidal se efectuó en gamma cámara híbrida (SPECT-CT) obteniéndose imágenes fusionadas anátomo-funcionales que demostraron la existencia y la localización exacta de tres focos de hiperplasia nodular focal.

Hiperplasia nodular focal do fígado: apresentação de um caso e revisão da literatura / Focal nodular hyperplasia of the liver: a case report and review of the literature

Neste trabalho apresentamos um caso de hiperplasia nodular focal que foi diagnosticado aos seis anos de idade e que está sendo acompanhado até o momento presente. Para o diagnóstico foram imprescindíveis as técnicas de imagem, tendo importância de realce a cintilografia hepatoesplênica e a tomografia computadorizada. Apresentamos, também, revisão da literatura sobre o assunto.

In this case report we discuss a focal nodular hyperplasia diagnosed in a female, six-year old patient, as well as her follow-up from the diagnosis to the present time. Imaging techniques, particularly hepatosplenic scintigraphy and computed tomography, are essential for the diagnosis. Also, a literature review is presented.