Tubulopapillary rectal adenocarcinoma in dog: clinical, surgical, pathological and immunophenotypical aspects: case report / Adenocarcinoma retal tubulopapilar em cão: descrição clínica, cirúrgica, anátomo-patológica e imunofenotípica: relato de caso

Intestinal carcinomas are rare in dogs. The prognosis and survival time are dependent of the histological type, the invasion of the intestinal wall by the malignant cells and the ability of primary neoplasm to produce metastasis. This study reports a case of a Yorkshire dog that developed a rectal tubulopapillary adenocarcinoma progressing to a peritoneal carcinomatosis and multiple metastasis in large intestines, bladder, kidney, iliac lymph node, liver and lungs, six months after transanal surgical resection of the primary rectal neoplasm. Clinical, surgical, pathological and immunophenotypic findings are described. COX-2 imunohistochemical score was higher in hepatic metastasis (score 9) than in the primary tumour (score 6), and the growth fraction (Ki-67) observed was of 49.2% in the rectal neoplasm.(AU)

Carcinomas intestinais são raros em cães. O prognóstico e a sobrevida são dependentes do tipo histológico, do grau de invasão nas camadas intestinais e da capacidade da neoformação primária em desenvolver metástases. Relata-se um caso de um cão, da raça Yorkshire, que desenvolveu adenocarcinoma tubulopapilar retal com evolução para carcinomatose peritoneal e múltiplos focos metastáticos no intestino grosso, na bexiga, no rim linfonodo ilíaco, no fígado e nos pulmões seis meses após ressecção cirúrgica da neoplasia primária. Aspectos clínicos, cirúrgicos, anatomopatológicos e imunofenotípicos são descritos. O escore de COX-2 na imuno-histoquímica foi maior na metástase hepática (escore 9) do que na massa primária (escore 6), e a fração de crescimento (Ki-67) na neoplasia retal foi de 49,2%.(AU)

Intestinal Diffuse Large B-Cell Lymphoma: An Evaluation of Different Staging Systems

The gastrointestinal tract is the most common primary extranodal site for diffuse large B-cell lymphoma (DLBCL). However, there is no consensus on the most appropriate staging system for intestinal DLBCL. We evaluated the utility of the modified Ann Arbor system, the Lugano system, and the Paris staging system (a modification of the Tumor, Node, Metastases [TNM] staging for epithelial tumors) in 66 cases of resected intestinal DLBCL. The cases were treated with surgery, plus either cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy alone (n=26) or with the addition of rituximab immunotherapy (n=40). Median follow-up time was 40.4 months (range, 2.1-171.6 months). Fifty-six patients (84.8%) achieved complete remission. The overall 5-yr survival rate was 86.4% (57/66). Of the stage categories defined for each staging system, only the T stage of the Paris classification showed prognostic significance for overall survival by univariate analysis. However, none of the stage parameters was significantly correlated with patient survival on multivariate analysis. In conclusion, the results suggest that the T stage of the Paris classification system may be a prognostic indicator in intestinal DLBCL. The results also imply that in surgically resected intestinal DLBCL, the addition of rituximab to the CHOP regimen does not confer significant survival advantage.

Neoplasias del intestino delgado / Small intestinal neoplasms

Small intestine tumors are infrequent lesions during the routine clinical practice. They appear sporadically, in association with genetic diseases (e.g familiar adenomatous polyposis or Peutz-Jeghers syndrome), or associated to chronic inflammatory diseases (e.g Crohn’s disease or celiac disease). Benign tumors of small intestine (e.g leiomyomas, lipomas, adenomas, hamartomas or desmoid tumors) are generally asymptomatic, and may show up with intussusception. Primary malignant small intestine tumors (e.g adenocarcinoma, leiomyosarcoma, carcinoid tumor and lymphoma), can appear with intestinal obstruction, jaundice, digestive bleeding or abdominal pain. Small intestine metastatic lesions can appear by nearness, peritoneal metastasis or by hematological way. This last dissemination type is infrequent and more typically of melanoma. Because of its low prevalence, unspecific symptomatology and relative inaccessibility by conventional endoscopy, the diagnostic of small intestine neoplasm is often made several months after the first symptoms. Enteroclysis is a useful imaging technique towards the small intestine neoplasm suspicion. The endoscopic capsule and enteroscopy are actually the best diagnostic and therapeutic methods for this type of neoplasm. The treatment depends in the type of neoplasm, being the tumoral resection the first-line therapy.

Los tumores de intestino delgado son lesiones infrecuentes en la práctica clínica habitual. Aparecen de forma esporádica en asociación con enfermedades genéticas (por ej., poliposis adenomatosa familiar o síndrome de Peutz-Jeghers), o bien asociados a enfermedades inflamatoria crónicas intestinales (por ej., enfermedad de Crohn o enfermedad celíaca). Los tumores benignos de intestino delgado (por ej., leiomiomas, lipomas, adenoma, hamartoma o tumor desmoide) son generalmente asintomáticos, pudiendomanifestarse con intususcepción. Los tumores malignos primarios de intestino delgado (por ej.,adenocarcinoma, leiomiosarcoma, carcinoide y linfoma), pueden presentarse con obstrucción intestinal, ictericia, sangramiento digestivo o dolor abdominal. Las lesiones metastásicas de intestino delgado pueden aparecer por contigüidad, metástasis peritoneal o por vía hematógena. Este último tipo de diseminación es infrecuente y más típico del melanoma. Debido a su baja prevalencia, sintomatología inespecífica y relativa inaccesibilidad por endoscopía convencional, el diagnóstico de las neoplasias de intestino delgado es realizado a menudo varios meses después de iniciado los síntomas. La enteroclisis es una técnica de imagen útil frente a la sospecha de neoplasia de intestino delgado. La cápsula endoscópica y la enteroscopía son los métodos actualmente de mayor rendimiento para el diagnóstico y eventual terapia de este tipo de neoplasias. El tratamiento depende del tipo de neoplasia, siendo la resección tumoral la terapia de primera línea.

Small intestinal tumours

Small bowel neoplasms continue to be an enigma to the clinicians. The insidious onset, the subtlety of the signs, the lack of definitive pre-operative diagnostic tests with often variable efficacies makes them difficult to diagnose. Small bowel consciousness is crucial in diagnosing and treating these tumours. This review aims to increase awareness of small bowel tumours in terms of epidemiology, diagnosis and treatment

Malignant gastrointestinal stromal tumor of intestine: a case report.

Smooth muscle tumors of the alimentary tract are uncommon.Cancer of small intestine comprises less than 20% of all malignant tumors. A 65-year-old male patient was admitted with complain of pain in abdomen since 7 days. He was diagnosed as a case of acute intestinal obstruction and on laparotomy an extraluminal mass was found at jejunoileal junction. Histopathology revealed a malignant gastrointestinal stromal tumor (GIST) which was confirmed by immunohistochemistry. The case is reported with review of literature and criteria for differentiation between benign and malignant tumors are enumerated.

Tumores de intestino delgado / Cancer of the small bowel

Los tumores primarios de intestino delgado (TID) son neoplasias poco comunes, representan menos del 10 por ciento de los tumores gastrointestinales. La mayoría de ellos son benignos (74 por ciento) y asintomáticos, sin embargo la mayoría de los que producen síntomas son malignos y requieren de tratamiento. Los más frecuentes son el adenocarcinoma y los tumores carcinoides ocasionando como principales manifestaciones al dolor, la obstrucción intestinal o la hemorragia. Habitualmente se diagnostican por endoscopia o estudios radiológicos contrastados y la forma de tratamiento es la cirugía. Dependiendo de la variedad histológica se utiliza la quimioterapia y/o radioterapia como tratamiento adyuvante, la sobrevida también depende de la estirpe histológica. Se revisó la experiencia del Instituto Nacional de Cancerología donde se analizaron 34 pacientes de los cuales la mayoría presentó dolor abdominal, náuseas, vómito y distensión. La variedad histológica más frecuente fue el adenocarcinoma (52 por ciento) seguido del leiomiosarcoma (32 por ciento). La mayoría (73 por ciento) fueron operados de los cuales 20 por ciento presentaban enfermedad metastásica al momento de la cirugía. Sólo nueve pacientes se encuentran vivos sin actividad tumoral con un seguimiento promedio de 7 meses. Con estos datos podemos concluir que los TID son raros, el diagnóstico en la mayoría se realiza en forma tardía y la cirugía continúa siendo el tratamiento de elección ya que ofrece la posibilidad de curación en algunos pacientes o paliación adecuada con procedimientos derivativos