Caracterización clínica, endoscópica e histológica de los pólipos colorrectales en pacientes de edades pediátricas. Matanzas / Clinical, endoscopic and pathological characterization of colorectal polyps in pediatric patients, Matanzas

Resumen Introducción: los pólipos del colon son los tumores más comunes del tracto gastrointestinal. Se presentan relativamente frecuentes en niños. El método eficaz para su diagnóstico es la colonoscopia que permite su tratamiento mediante la polipectomía. Objetivo: determinar las características clínicas, endoscópicas e histológicas de los pólipos colorrectales, diagnosticados en niños atendidos en el Hospital Pediátrico Provincial "Eliseo Noel Caamaño", de la ciudad de Matanzas. Materiales y métodos: se realizó un estudio descriptivo, retrospectivo en niños diagnosticados con pólipos colorrectales y atendidos en el hospital. En el período comprendido del 2010 al 2018. Se estudiaron 141 pacientes menores de 18 años, con diagnóstico de pólipos por colonoscopia confirmado en el estudio histológico. Se excluyeron los pacientes con diagnósticos diferentes a pólipos y aquellos que no se pudieron estudiar histológicamente. Resultados: se observó mayor frecuencia de pacientes con pólipos en las edades entre 1 y 10 años (37,6 %), del sexo masculino (57,4 %). Los síntomas más frecuentes fueron el sangramiento digestivo bajo, (96,3 %) y prolapso de masa T por el recto, (27 %). Los pólipos estudiados se localizaron con mayor frecuencia en rectosigmoide (73, 4 %), predominando los pólipos únicos (78 %), pediculados (56,2 %), de 1-2 cm de tamaño (53,2 %). Histológicamente predominaron los pólipos juveniles, (62,1 %) seguidos de los inflamatorios (33 %). Conclusiones: los pólipos fueron más frecuentes en las edades de 1 y 10 años y en el sexo masculino. Se demostró la importancia de la colonoscopia en el diagnóstico precoz de estas lesiones (AU).

ABSTRACT Introduction: colon polyps are the most common tumors of the gastrointestinal tract. They are found relatively frequently in children. The efficacious method for their treatment is the colonoscopy, allowing their treatment through polypectomy. Objective: to determine the histological, endoscopic and clinical characteristics of colorectal polyps diagnosed in children who attended the Pediatric Provincial Hospital "Eliseo Noel Caamaño", of Matanzas. Materials and methods: a retrospective, descriptive study was carried out in children diagnosed with colorectal polyps in the hospital in the period from 2010 to 2018. 141 patients under 18 years-old were studied, all with diagnosis of polyps by colonoscopy confirmed in the histological study. The patients with different diagnosis but polyps were excluded, and also those who could not be histologically studied. Results: the highest frequency of patients with polyps was found in ages between 1 and 10 years (37,6 %), and the male sex (57.4 %). The most frequent symptoms were low digestive bleeding (96.3 %) and Mass T prolapse through the rectum (27 %). The studied polyps were more frequently located in the rectosigmoid (73.4 %). The single polyps predominated (78 %)m and the pedunculated ones (56.2 %) of 1-2 cm size (53.2 %). Histologically predominated young polyps (62.1 %), followed by the inflammatory ones (33 %). Conclusions: polyps were more frequent at the ages from 1 to 10 years and in the male sex. The authors showed the importance of colonoscopy in the precocious diagnosis of these lesions (AU).

Perianal leiomyoma / Leiomioma de localização perianal

Abstract Leiomyomas are smooth muscle tumors and may occur in places where these fibers are present, while the anorectal location is rare. They are commonly incidental imaging findings and in most cases, patients are asymptomatic. The therapeutic recommendation is tumor resection and postoperative follow-up. Case report: a 38-year-old Black woman had, one year ago, a swelling in perianal right region, which showed slow and progressive growth. She denied bowel habit alterations, local pain, hematochezia, or tenesmus. Proctologic examination showed a fibroelastic, regular, mobile, painless nodule measuring 10 cm at its largest diameter in the right perianal region, next to the anal verge. The soft tissue ultrasound image identified a solid, hypoechoic, and discreetly vascularized nodule in the perianal, superficial right gluteal region that did not reach the adjacent muscles. A complete resection of perineal tumor was carried out in the ventral position. Histological and immunohistochemical analyses disclosed a leiomyoma with a positive finding for actin smooth muscle and negative for desmin. She is currently asymptomatic and undergoing outpatient follow-up.

Resumo Os leiomiomas são tumores da musculatura lisa podendo ocorrer nos locais onde essas fibras estão presentes, sendo rara a localização anorretal. Na maioria dos casos os pacientes são assintomáticos, sendo comumente achados de exame de imagem. A recomendação terapêutica é a ressecção tumoral e o seguimento pós-operatório. Relato do caso: mulher, 38 anos, negra. Há um ano, apresentou abaulamento em região perianal direita, de crescimento lento e progressivo. Negava alteração do hábito intestinal, dor local, hematoquezia, puxo ou tenesmo. Ao exame proctológico, apresentava nodulação fibroelástica, regular, móvel, indolor, com 10 cm de diâmetro em região perianal à direita, próxima à borda anal. Realizou ultrassonografia de partes moles que identificou imagem nodular, sólida, hipoecogênica e discreta vascularização em parte superficial perianal e glútea direita, não envolvendo musculatura adjacente. Foi submetida à ressecção completa do tumor via perineal, em posição ventral. O laudo histológico e imuno-histoquímico revelou leiomioma, com achado positivo para actina de músculo liso e negativo para desmina. Atualmente está assintomática, em seguimento ambulatorial.

Salvamento de extremidad con resección extraarticular de rodilla / Limb-salvage surgery with extra-articular resection of the knee

Cuando tenemos un tumor óseo maligno del fémur distal con contaminación de la articulación, ya sea por extensión del tumor, fracturas secundarias al tumor con trazo intraarticular o contaminación en una biopsia tomada de manera inadecuada, debemos realizar resecciones extraarticulares de rodilla para lograr un control primario del tumor. Podemos emplear varias técnicas para lograr este fin, y una buena reconstrucción; la técnica que empleamos es la resección extraarticular más la preservación del mecanismo extensor, poco conocida en nuestro medio y de la cual es pionera el instituto Nacional de Cancerología. Con ella, hemos logrado un adecuado control tumoral primario de las lesiones óseas malignas en el fémur distal, menor número de complicaciones, una rápida rehabilitación y retorno a sus actividades habituales. Por esto, el interés de dar a conocer dicha técnica en los grupos de ortopedia oncológica, para que haga parte de su armamentario quirúrgico habitual.

When we encounter a malignant bone tumor in the distal femur with contamination of the joint, whether caused by tumor extension, secondary tumor fractures with intra-articular traces, or by contamination produced by inadequate taking of biopsies, extra-articular knee resection must be performed in order to achieve primary tumor control. Several methods are at our disposal to do so; our reconstruction technique of choice is that of extra-articular resection plus preservation of the extensor mechanism. this method is not well known locally; however, the National Cancer institute of Colombia has pioneered its use, thus allowing us to attain adequate primary tumor control in malignant bone lesions in the distal femur, with fewer complications, rapid rehabilitation and more immediate return to daily activities. We are, therefore, interested in sharing our expertise on this method with orthopedic oncologists so that they may include it their armory of standard surgical procedures.