Consenso chileno de diagnóstico y manejo de neoplasias quísticas pancreáticas. Club de páncreas Chile-SCHGE / Chilean consensus on diagnosis and management of pancreatic cystic neoplasms

Pancreatic cystic neoplasms (PCN) are frequently detected on abdominal images performed for non-pancreatic indications. Their prevalence in asymptomatic population ranges from 2.7 to 24.8%, and increases with age. There are several types of pancreatic cysts. Some may contain cancer or have malignant potential, such as mucinous cystic neoplasms, including mucinous cystadenoma (MCN) and intraductal papillary mucinous neoplasms (IPMN). In contrast, others are benign, such as serous cystadenoma (SCA). However, even those cysts with malignant potential rarely progress to cancer. Currently, the only treatment for pancreatic cysts is surgery, which is associated with high morbidity and occasional mortality. The Board of the Chilean Pancreas Club of the Chilean Gastroenterology Society developed the first Chilean multidisciplinary consensus for diagnosis, management, and surveillance of PCN. Thirty experts were invited and answered 21 statements with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree. A consensus was adopted when at least 80% of the sum of the answers "fully agree" and "partially agree" was reached. The consensus was approved by the Board of Directors of the Chilean Pancreas Club for publication.

Alteración de la fertilidad masculina por hiperplasia suprarrenal congénita: Azoospermia reversible con terapia de glucocorticoide / Congenital adrenal hyperplasia causing male infertility: Report of one case

In males, congenital adrenal hyperplasia due to 21 hydroxylase deficiency is associated to normal fertility or infertility caused by a hypogonadotrophic hypogonadism (HH) or gonadal damage caused by intratesticular adrenal remnants. We report a 29-year-old male with azoospermia, without any important personal or family background. Physical examination was normal, his height was 150 cm and his testicular volume was 10 ml (normal 15 to 25 ml). Laboratory showed a normal testosterone and FSH and LH in the low normal limit. These results discarded a HH, whose diagnostic requirements are a low testosterone and inadequately normal or low gonadotrophins. A testicular biopsy was informed as compatible with HH. A 21 hydroxylase deficiency was suspected and confirmed with extremely high levels of 17 hydroxyprogesterone at baseline and after stimulation with fast acting ACTH. Clomiphene citrate did not increase testosterone or gonatrophin levels. Testicular ultrasound discarded the presence of adrenal nodules. Betametasone therapy resulted in a normal testicular development, normalization of sperm count, reduction of 17 hydroxyprogesterone and testosterone levels with an ulterior rise of the latter. Spontaneous paternity was achieved twice. It must be remembered that in cases of azoospermia due to congenital adrenal hyperplasia, testosterone produced by adrenal glands hinders the laboratory diagnosis of HH.

Tumor de Wilms: histopatología y pronóstico / Wilms' tumor: histopathology and prognosis

Se analizan 40 casos de tumor de Wilms con el objeto de establecer la relación existente entre los estadios clínicos, la histopatología del tumor y el pronóstico del mismo, así como la frecuencia de presentación de cada uno de los subtipos histológicos. El mayor porcentaje de nuestros casos correspondían al tipo histológico mixto, seguido de la variedad epitelial, blastematosa y estromatosa. El 77.5% de los casos correspondían a subtipos histológicos de "pronóstico favorable" y el 22% a subtipos histológicos de "pronóstico desfavorable" (con anaplasia o componentes sarcomatosos). Se observó una mortalidad menor en los estadios I y II de la clasificación del NWTS, los que a su vez muestran un mayor porcentaje de subtipos histológicos de pronóstico favorable. Se observó un peor pronóstico en los pacientes cuyos tumores correspondían a la variedad sarcomatosa o que presentaban anaplasia. En ellos la mortalidad fue de un 55.5% en contraposición con los otros subtipos, en los cuales esta fue de un 25.5%. Todos los casos con anaplasia correspondían al tipo mixto, sin que se observaran diferencias significativas en la mortalidad de este grupo entre los subtipos con o sin anaplasia. Los resultados de este estudio confirman la importancia de que la clasificación histológica del tumor de Wilms, en grupos de pronóstico favorable y desfavorable, sea parte integral del protocolo de tratamiento de los pacientes con este tumor