Neoplasia papilar intracolecística: reporte de un caso y revisión de la evidencia existente / Intracholecystic papillary neoplasia: report of a case and review of existing evidence

La neoplasia papilar intracolecística (NPIC), es un tumor compuesto por células neoplásicas preinvasivas, que forman masas de hasta 1,0 cm, clínicamente detectables. El objetivo de este estudio fue reportar un caso de NPIC y revisar la evidencia existente. Se trata de un paciente sexo masculino, de 33 años de edad, asintomático, que en el curso de un examen de salud, se realiza una ecotomografía abdominal, en la que se verifica una lesión polipoide vesicular de 32 x 19 mm de diámetro. Se programa para colecistectomía electiva, la que se realizó por vía laparoscópica, cirugía que se pudo realizar sin inconvenientes. Una vez extirpado el espécimen, se fue a estudio histopatológico en el que tras un mapeo vesicular se concluye NPIC, colecistitis crónica inespecífica, colesterolosis y pólipos colesterínicos. El paciente ha evolucionado sin inconvenientes. Presentamos un caso de NPIC en un paciente joven, cuyo diagnóstico fue confirmado por anatomía patológica tras una colecistectomía electiva, descartándose la presencia de carcinoma invasivo y displasia de alto grado, por lo que el pronóstico es favorable.

Intracholecystic papillary neoplasm (ICPN) is a tumor composed of pre-invasive neoplastic cells, with up to 1.0 cm clinically detectable masses. The objective of this study was to report a case of NPIC and review the evidence in the literature. A 33-year-old asymptomatic male patient had an abdominal ultrasonography during a health examination, in which a vesicular polyp lesion of 32 x 19 mm in diameter was verified. Thepatient was subsequently scheduled for elective cholecystectomy, which was performed laparoscopically and the surgery was uneventful. Once removed, the specimen was studied histopathologically and after performing vesicular mapping, we determined an ICPN, chronic non-specific cholecystitis, cholesteroliasis and cholesteric polyps. The patient has evolved without reported problems. We present a case of ICPN in a young patient, whose diagnosis was confirmed by pathological anatomy after an elective cholecystectomy, ruling out the presence of invasive carcinoma and high-grade dysplasia, with a favorable prognosis.

Adenocarcinoma Arising from Heterotopic Pancreas in Association with a Splenic Cyst.

We report a rare case of adenocarcinoma arising from heterotopic pancreas in splenectomy specimen operated for a Splenic Cyst. This 40 year old female patient presented with vague upper abdominal pain and swelling. USG showed a large cyst within the spleen. The cyst along with the spleen is removed after laparotomy. The pancreas and other abdominal organs were unremarkable on ultrasonography and intraoperative examination. Gross examination showed a cyst with a smooth lining, entirely within the spleen. A small locule, communicating with the main cyst showed small papillary projections. On light microscopy, the cyst wall is lined by single layer of columnar cells. Section from papillary areas showed histological appearance of papillary adenocarcinoma. Remnant of normal pancreatic tissue was discovered at the wall of the cyst. We presume an origin from heterotopic pancreatic tissue in the spleen for this neoplasm and reporting the case for its rarity.

Carcinoma de parótida e mama concomitantes: relato de caso / Parotid carcinoma concomitant with breast carcinoma: case report

O risco de desenvolvimento de câncer de mama em pacientes que apresentam carcinoma de glândula salivar é discutido desde 1968. Entretanto, não foi encontrado um fator causal comum responsável por esta associação. Os autores relatam um caso de adenocarcinoma papilífero de parótida direita, em uma paciente de 85 anos que também apresentava sincronicamente um carcinoma ductal invasivo da mama ipsilateral à neoplasia da parótida. Clinicamente haviam dados para a malignidade em ambas as lesões. O diagnóstico foi confirmado por citologia da parótida e histologicamente por biópsia na mama. A proposta inicial foi de parotidectomia mais esvaziamento cervical unilateral modificado e mastectomia. A paciente recusou-se ao procedimento de mastectomia, apenas aceitou a proposta cirúrgica para a parótida. Foi realizado parotidectomia total mais esvaziamento cervical modificado, para avaliação radioterápica pós-operatória e uso de tamoxifen para a patologia mamária. Houve uma resposta satisfatória importante na neoplasia da mama, com conseqüente involução da mesma, mas houve recidiva do adenocarcinoma na região parotídea direita, um ano após a primeira cirurgia. Nesta ocasião, realizou-se a ressecção da recidiva com esvaziamento clássico e reconstrução com retalho delto peitoral porque havia comprometimento da pele. Atualmente, após o último procedimento, a paciente vem em controle ambulatorial sem sinais de recidiva local...

Papillary adenocarcinoma of the stomach with psammoma bodies: report of two cases

Calcification of gastric carcinoma is unusual and most of the reported cases were of the mucinous type. This report describes two cases of papillo-tubular adenocarcinoma of the stomach with psammomatous calcification confined only to the papillary portion. Calcification was so heavy that specimen X-ray was able to clearly delineate its distribution. Microscopically, the calcification was confined to the papillary carcinoma area and was not found in the area of the tubular adenocarcinoma. Polymorphic calcific bodies were found in the supportive stroma of papillae and extrapapillary spaces as concentrically laminated psammoma bodies. They were also found in tumor cells as minute corpuscles. The mechanism of neoplastic mineralization in these cases seemed different from ontogenic calcification of mucinous gastric carcinoma and we postulated the mechanism of psammomatous calcification which is referred as intracellular calcification.

Papillary adenocarcinoma of duodenum

Um caso de adenocarcinoma da regiäo infra-ampular do duodeno é reportado. A raridade do tumor, a dificuldade do diagnóstico e os bons resultados adquiridos com uma ressecçäo segmentar da terceira e quarta porçöes do duodeno e jejuno proximal, com anastomose duodeno-jejunal säo discutidos. Uma revisäo de recentes artigos sobre o assunto é apresentada.