RESUMO
Introducción: los tumores estromales gastrointestinales (GISTs)son un grupo eterogéneo de neoplasias mesenquimáticas, controvertidas para muchos en cuanto a morfología, criterios diagnósticos y comportamiento. Datos clínicos: se revisaron todos los tumores mesenquimáticos gastrointestinales de archivo del período 1992-2002. Se hallaron 7 casos de GISTs (25 por ciento de los tumores mesenquimáticos): 4 mujeres y 3 hombres, de 53 a 89 años; 5 fueron de estámago, 1 de intestino delgado y 1 de trascavidad de los epiplones. Métodos disgnósticos: el material se procesó según técnicas de rutina y se coloreó con H.E. Se efectuó IHQ para Actina Músculo Liso (AML), Desmina, S 100, CD 117. Hallazgo macroscópicos: todos los casos correspondieron a piezas quirúrgicas (gastrectomía, resección segmentaria intestinal o tumorectomía). El tamaño tumoral osciló entre 4 y 25 cm. Hallazgos microscópicos: consistieron en proliferaciones fusiformes, con grado variable de celularidad, atipía y actividad mitótica (AM)...
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Neoplasias GástricasRESUMO
Duplication is defined as the presence of a complete or partial double structure, with a variable length. In esophagus, duplications, diverticuli and cysts might be manifestations of the same embriologic defect. The most common is the Cystic Duplication of the esophagus (CDE), which represents the esophageal duplication, either spherical or tubular, with squamous or columnar epithelium, and a double muscular layer. Clinical Case: male, 38 years old with no previous relevant data, and sudden, complete and persistent post ingestion aphagia, intense presternal pain, and a 12 Kg. weight loss in 15 days. Endoscopy showed unsurpassable stenosis of the lower third of the esophagus, with normal mucosa. Total esophagectomy and replacement with a gastric tube, was performed. He had a good postoperative course. PATHOLOGY: A total esophagectomy open specimen showing a cystic structure at the posterior wall was submitted, which showed a thick, muscular-like wall and hemorrhagic internal surface. Microscopically it had a pseudostratified columnar, ciliated epithelium, alternating with sloughed hemorrhagic areas, fibrosis and stromal siderophagi Leiomuscular double-layered wall. CDE is very infrequent, and is the second most frequent after leiomiomas as a benign esophageal mass. From 10 to 15 percent of all digestive duplications take place at the esophagus. There are different theories to explain its origin. Differential diagnosis must be made mainly with brochogenic cyst, generally anterior and with cartilage. Treatment is surgical.
Assuntos
Humanos , Masculino , Adulto , Cisto Esofágico , Esôfago , Epitélio , Cisto Esofágico , Esofagectomia , EsôfagoRESUMO
Multiple carcinomas were searched in 50 successive gastrectomies, 17 females (34 percent) 33 males (66 percent) from 40 to 83 years old. Macroscopic handling of the specimens included pinning an a board, fresh, half-fixed and completely fixed examination, not only by naked eye but also through a magnifying glass. The stomach were totally studied, according to japanese method. A satisfactory slide was obtained from each block, stained with H.E. and examined by each of the authors. Synchronous tumors were found in 4 cases (8 percent), 3 males and one female. Compared to the main lesion, two cases showed a proximal tumor, one case showed a distal tumor, and the last one showed two tumors, one of them proximal and the other distal. Three tumors were macroscopically and two were microscopically detected. Two of them coexisted with advanced carcinoma and three with early carcinoma. Four of them were located in mucosa with intestinal metaplasia. Histologically, four cases belong to the same type of the original tumor, and one of them did not coincide. We conclude that stomachs resected for cancer must be thoroughly and methodically studied before and after fixation. We suggest that resection must include the whole mucosa with intestinal metaplasia, in order to avoid leaving a synchronous tumor in the gastric stump.