Infrecuente complicación de páncreas ectópico: obstrucción intestinal por pseudoquiste pancreático en píloro / Infrequent complication of heterotopic pancreas: intestinal obstruction by pancreatic pseudocyst in pylorus

Resumen: Presentamos un caso un hombre de 53 años con antecedentes de reflujo gastroesofágico y pirosis con varias visitas al servicio de urgencias por vómitos, con antecedentes de consumo crónico de alcohol. La TC sin y con contraste endovenoso mostró a nivel del píloro una lesion ovoidea de paredes gruesas con captación similar al tejido pancreático, con un gran componente quístico bien delimitado que condiciona una obstrucción intestinal. La ecografía confirma la presencia de una lesión quística con ecos móviles en su interior. Tras la realización de antrectomía, el estudio histológico revela un pseudoquiste pancreático sobre páncreas ectópico, siendo esta presentación muy infrecuente, con pocos casos descritos hasta la fecha. Conclusión: Los hallazgos clínico-radiológicos con TC y US de páncreas ectópico pueden orientar el diagnóstico, aunque no son concluyentes. El diagnóstico definitivo se realiza mediante estudio histológico.

Abstract: A 53 year-old male with a past history of chronic alcohol intake, presents with an intestinal obstruction. A CT scan shows an ovoid tumor in pylorus with a great cystic component, thick wall and delimited rim, causing gastric retention. Its walls have similar enhancing pattern as the pancreatic tissue. Ultrasound revealed the presence of a cystic tumor with mobile echoes inside. After antrectomy the histological study reports pancreatic pseudocyst hosted in ectopic pancreas. This is an unusual presentation and only a few cases have been reported. Conclusion: The clinical and radiographic findings of ectopic pancreas are non-specific. Definitive diagnostic requires histological study.

Intrathoracic kidney with left-sided Bochdalek hernia in a woman with bacteremic acute pyelonephritis due to Escherichia coli

No abstract available.

Nonadenomatous nonencapsulated thymic parathyroid tissue concomitant with primary hyperparathyroidism due to ectopic parathyroid adenoma / Tecido tímico paratireoidiano não edematoso e não encapsulado concomitante com hiperparatireoidismo devido a adenoma paratireoidiano ectópico

Primary hyperparathyroidism due to ectopic parathyroid adenoma is not infrequent. Primary hyperparathyroidism caused by unusual thymic nonadenomatous nonencapsulated parathyroid tissue has been reported before. Both can cause unsuccessful neck explorations. Here we presented for the first time a patient with hyperparathyroidism due to ectopic parathyroid adenoma concomitant to the presence of thymic nonadenomatous nonencapsulated parathyroid tissue.

O hiperparatireodismo primário devido a adenoma ectópico paratireoidiano não é raro. O hiperparatireodismo primário causado por tecido tímico paratireoidiano não edematoso e não encapsulado incomum já foi relatado anteriormente. Ambos podem levar à exploração cervical malsucedida. Apresentamos aqui, pela primeira vez, uma paciente com hiperparatireoidismo decorrente de um adenoma paratireoidiano concomitante com a presença de tecido tímico paratireoidiano não edematoso e não encapsulado.

Congenital esophageal stenosis owing to tracheobronchial remnants / Estenosis congenita del esofago por remanecientes traqueobronquicos: relato de cuatro casos / Estenose congenita do esofago por remanescentes traqueobronquicos

OBJECTIVE To emphasize the need of an accurate diagnosis of congenital esophageal stenosis due to tracheobronchial remnants, since its treatment differs from other types of congenital narrowing. CASE DESCRIPTION Four cases of lower congenital esophageal stenosis due to tracheobronchial remnants, whose definitive diagnosis was made by histopathology. Except for the last case, in which a concomitant anti-reflux surgery was not performed, all had a favorable outcome after resection and anastomosis of the esophagus. COMMENTS The congenital esophageal stenosis is an intrinsic narrowing of the organâ€(tm)s wall associated with its structural malformation. The condition can be caused by tracheobronchial remnants, fibromuscular stenosis or membranous diaphragm and the first symptom is dysphagia after the introduction of solid food in the diet. The first-choice treatment to tracheobronchial remnants cases is the surgical resection and end-to-end anastomosis of the esophagus. .

OBJETIVO Enfatizar la necesidad de un diagnóstico preciso de estenosis congénita del esófago por remanecientes traqueobrónquicos, una vez que su tratamiento difiere de los otros tipos de estrechamiento congénito. DESCRIPCIÓN DEL CASO Cuatro casos de estenosis congénita del esófago inferior causada por remanecientes traqueobrónquicos, cuyo diagnóstico definitivo fue obtenido por examen histopatológico. Excepto por el último caso, en el que no se utilizó cirugía antirreflujo concomitante, todos presentaron evolución satisfactoria después de resección y anastomosis del esófago. COMENTARIOS La estenosis congénita del esófago consiste en el estrechamiento intrínseco de la pared del órgano asociado a la malformación de su estructura. Puede ser causada por restos traqueobrónquicos, espesamiento fibromuscular o diafragma membranoso y tiene como primera manifestación clínica disfagia después de la introducción de alimentos sólidos en la dieta. El tratamiento de elección para los casos de remanecientes traqueobrónquicos es la resección del segmento estenosado con anastomosis término-terminal. .

OBJETIVO Enfatizar a necessidade de um diagnóstico preciso de estenose congênita do esôfago por remanescentes traqueobrônquicos, já que seu tratamento difere dos outros tipos de estreitamento congênito. DESCRIÇÃO DO CASO Quatro casos de estenose congênita do esôfago inferior causada por remanescentes traqueobrônquicos, cujo diagnóstico definitivo foi obtido por exame histopatológico. À exceção do último caso, em que não se realizou cirurgia antirrefluxo concomitante, todos apresentaram evolução satisfatória após ressecção e anastomose do esôfago. COMENTÁRIOS A estenose congênita do esôfago consiste no estreitamento intrínseco da parede do órgão associada à malformação de sua estrutura. Pode ser causada por restos traqueobrônquicos, espessamento fibromuscular ou diafragma membranoso e tem como primeira manifestação clínica disfagia após introdução de alimentos sólidos na dieta. O tratamento de escolha para os casos de remanescentes traqueobrônquicos é a ressecção do segmento estenosado com anastomose término-terminal. .

Ectopia amigdalina cerebelosa borderline en un niño con cefalea. Caso clínico / Borderline cerebellar tonsillar ectopia in a child with headache. Case report

La cefalea es un síntoma que conlleva un malestar signifcativo y deterioro funcional en quienes lo sufren con frecuencia, tanto en la infancia como en la edad adulta. Algunas afecciones se asocian con una mayor frecuencia de cefaleas. La ectopia amigdalina cerebelosa borderline, defnida como la protrusión de las amígdalas cerebelosas por foramen magnum), es una de esas afecciones. Aunque no está claro el signifcado clínico de esta entidad como causa de cefalea, hay estudios que informaron su asociación en el 16% de los pacientes. Se presenta el caso de un paciente de 9 años que acudió a la consulta por padecer una cefalea frontal de 5 años de evolución. Se diagnosticó ectopia amigdalina cerebelosa borderline mediante una resonancia magnética. Se describe este caso dado lo atípico de la presentación de esta entidad en la infancia.

Frequent headache is a symptom that leads to signifcant distress and functional impairment, both in childhood and in adulthood. Some medical conditions are associated with a higher frequency of headaches. Borderline cerebellar tonsillar ectopia which may be defned as the downward extension of cerebellar tonsils of < 5 mm below the foramen magnum is among these conditions. Although questions persist about the clinical signifcance of this rare entity on headache, there are studies reporting severe headache syndrome in 16% of these patients. We report a 9-year old male patient, who presented to our clinic with a frontal headache of 5 years' duration, and was found to have borderline cerebellar tonsillar ectopia on magnetic resonance imaging. To the best of our knowledge, there has not been a reported case of this coexistence at this early stage of life. We would like to contribute to the literature, owing to the very rare and atypical presentation of this entity in the early childhood period.

Persistent primary hyperparathyroidism: an uncommon location for an ectopic gland - Case report and review / Hiperparatiroidismo primário persistente: glândula ectópica em localização rara - Caso clínico e revisão

Primary hyperparathyroidism (PHPT) is a common endocrine disorder that mainly affects middle-aged women. Patients are usually asymptomatic. The disease might be ascribable to hyperplasia, carcinoma, and single or multiple adenomas. PHPT may be sporadic or familial, the latter comprising multiple endocrine neoplasia type 1 or 2A, familial benign hypocalciuria hypercalcemia, and hyperparathyroidism-jaw tumor syndrome. The most common causes for persistent PHPT are multiglandular disease, and missed abnormal ectopic or orthotopic parathyroid glands. Imaging localization studies should precede a new surgical intervention. Ectopic parathyroid glands are rarely located at the aortopulmonary window. For diagnosis confirmation, 99mTc-sestamibi SPECT/CT seems to be an advantageous test. Another possibility is to perform 99mTc-sestamibi followed by thoracic CT or MRI. Parathyroidectomy may be performed by means of median sternotomy, thoracotomy, or video-assisted thoracoscopy. We describe a case of persistent primary hyperparathyroidism due to the presence of an ectopic parathyroid gland found at the aortopulmonary window. As the investigation necessary to clarify the etiology of recurrent nephrolithiasis proceeded, the diagnosis of PHPT was determined. The patient underwent subtotal parathyroidectomy; nevertheless, PHPT persisted. Genetic syndromes that could account for this condition were excluded. Imaging studies available at that time were not able to locate abnormal glands; moreover, the patient refused to undergo surgical exploration. Later, the patient underwent 99mTc-sestamibi SPECT/CT, which revealed a parathyroid gland at the aortopulmonary window.

O hiperparatiroidismo primário (HPP) é uma endocrinopatia frequente que afeta maioritariamente mulheres de meia-idade e é geralmente assintomática. A doença pode ser atribuível a hiperplasia, carcinoma, adenomas únicos ou múltiplos. O HPP inclui formas esporádicas e familiares. As formas familiares englobam neoplasia endócrina múltipla tipo 1 ou 2A, hipercalcemia hipocalciúrica familiar e síndrome hiperparatiroidismo/tumor mandibular-maxilar. As causas mais frequentes de HPP persistente são a presença de doença multiglandular ou de paratiroide anômala ectópica ou ortotópica não identificada previamente. É recomendável que a localização imagiológica preceda a reintervenção cirúrgica. A janela aortopulmonar é uma localização ectópica rara, sendo o 99mTc-sestamibi SPECT/TC um exame de confirmação vantajoso ou, alternativamente o 99mTc-sestamibi seguido de TC ou RM torácica. A paratiroidectomia pode ser efetuada por meio de esternotomia mediana, toracotomia ou toracoscopia videoassistida. Descrevemos um caso de HPP persistente atribuível à presença de uma glândula paratiroide ectópica localizada à janela aortopulmonar. O diagnóstico de HPP foi estabelecido na sequência da investigação requisitada para esclarecimento etiológico da nefrolitíase recidivante constatada nessa doente. Foi submetida à paratiroidectomia subtotal; não obstante, o HPP persistiu. Excluíram-se síndromes genéticas que pudessem justificar esse quadro clínico. Os exames imagiológicos disponíveis (à época) revelaram-se infrutíferos na detecção de paratiroides anômalas; adicionalmente, a doente recusou exploração cirúrgica. Posteriormente, a doente foi submetida a 99mTc-sestamibi SPECT/TC, que revelou a presença de uma paratiroide na janela aortopulmonar.

Presentación de un caso de tejido salival heterotópico cervical asociado con un quiste branquial / A case of salivary heterotopic tissue associated with branchial cyst

Las masas cervicales en los adultos jóvenes responden a adenopatías inflamatorias, malformaciones congénitas o menos frecuentemente a neoplasias. El tejido salival heterotópico es la presencia de tejido salival en un lugar anormal. Cuando tiene ubicación cervical puede encontrarse asociado con anomalías branquiales, al parecer por la relación que tienen ambos durante su embriogénesis. Por lo poco frecuente de esta asociación y no encontrarse publicado ningún caso en la literatura nacional, se decide la presentación del caso de una paciente joven con una masa cervical, con diagnóstico presuntivo de quiste branquial, que al intervenirla quirúrgicamente, se constata formación de aspecto glandular asociado con la lesión quística, con confirmación histopatológica de tejido salival heterotópico cervical asociado con quiste branquial. Se exponen además las posibles teorías de esta asociación según autores revisados en la literatura mundial y se confirma la importancia de tener en cuenta este diagnóstico ante una tumoración cervical para poder planear el tratamiento quirúrgico adecuado(AU)

In adult people cervical masses account for inflammatory adenopathies, congenital malformations or in a lesser degree to neoplasms. Heterotopic salivary tissue is the presence of salivary tissue in an abnormal place. When it has a cervical location may to be associated with branchial anomalies apparently by its relation (both) during the embryogeny. Due to the non-frequent of this association and the no publication of any case in national literature, we decide a case presentation of the case of a young patient with a cervical mass presumptively diagnosed with branchial cyst and in surgical intervention we noted a glandular development associated with the cystic lesion with histopathology confirmation of cervical heterotopic salivary tissue linked to branchial cyst. We showed also the potential theories of this association according the authors reviewed in world literature and we confirmed the significance of to take into account this diagnosis in case of a cervical tumor to plan the appropriate surgical treatment(AU)

Intestinal perforation by multiple ectopic pancreatic tissues in a neonate with multiple congenital anomalies

Ectopic pancreatic tissues of the gut are usually found incidentally during laparotomy or are reported in the autopsy findings. Rarely these ectopic pancreatic tissues may cause symptoms such as hemorrhage, pancreatitis, intussusception or perforation. We present a case report of the presence of multiple ectopic pancreatic tissues in the gut causing hemorrhage and perforation in a preterm, extremely low birth weight neonate with multiple congenital anomalies

Transverse testicular ectopia with persistent Muellerian duct syndrome.

A one-year-old boy was admitted with complaints of swelling in the left inguinoscrotal region and an empty right scrotum since birth. The inguinoscrotum contained two ovoid solid swellings one above the other. The swellings were testes like in feel, size and shape. The diagnosis was transverse testicular ectopia. The case was managed by surgery. Tissue from gonads, the tubular structures and the fallopian tubes were sent for histopathological examination for confirmation. This was a case of an otherwise normal male with transverse testicular ectopia with persistent Muellerian duct syndrome in the left inguinoscrotal hernial sac.

Gastric heterotopia together with squamous metaplasia in the gallbladder / Heterotopía gástrica y metaplasia escamosa en la vesícula biliar

Heterotopic gastric mucosa in the gallbladder is extremely unusual. In this study, we aimed to report a case of gastric heterotopia together with squamous metaplasia in the gallbladder of a 47-year-old female patient who experienced an intensive abdominal pain. He was admitted to the hospital for clinical treatment without any improvement. Ultrasonography showed a stone located in the gallbladder neck and dilatation of intrahepatic bile ducts, both hepatic ducts and common hepatic duct. Laparoscopic cholecystectomy was performed. In the microscopical examination, the epithelium of the gallbladder revealed an unspecified chronic cholecystitis. Besides, at the level of the gallbladder body, a heterotopic gastric mucosa contain chief, parietal and mucosal cells with cystic glands and squamous metaplasia was found. Actually the patient is in long-time follow-up, asymptomatic. We also review 96 other reports of HGM in the gallbladder in the international medical literature from 1934. As heterotopic tissue may promote carcinogenesis of the gallbladder, close attention should be paid to any occurrence of such lesions in this anatomical region. It appears that laparoscopic cholecystectomy may be unavoidable for patients affected by heterotopic gastric mucosa at the present time and care must be taken when a diagnosis is made based on intraoperative frozen sections.

La heterotopía de la mucosa gástrica (HGM) en vesícula biliar es extremadamente rara. En este estudio, reportamos un caso de heterotopía gástrica junto con metaplasia escamosa en vesícula biliar de un paciente femenino de 47 años que experimentó un dolor abdominal intenso. Lo admitieron al hospital para el tratamiento clínico sin ninguna mejoría. Ultrasonografía demostró un cálculo situado en el cuello de la vesícula y dilatación de conductos biliares intrahepáticos, los conductos hepáticos y conducto hepático común. Se realizó la colecistectomía por vía laparoscópica. En el exámen microscópico el epitelio reveló una colecistitis crónica inespecífica. Además, en el nivel del cuerpo de la vesícula biliar fue hallada una mucosa gástrica heterotópica con células principales, parietales, células mucosas con las glándulas enquistadas y metaplasia escamosa. El paciente está en el seguimiento a largo plazo, asintomático. Revisamos 96 informes de HGM en vesícula biliar en la literatura médica internacional a partir de 1934. El tejido heterotópico puede promover la carcinogénesis de la vesícula biliar, por lo cual se debe prestar atención a cualquier ocurrencia de tales lesiones en esta región anatómica. La colecistectomía laparoscópica puede ser inevitable para los pacientes afectados por la mucosa gástrica heterotópica actualmente y todo cuidado debe ser tomado cuando se hace un diagnóstico por secciones congeladas intraoperatorias.

Ectopic canine tooth: a rare cause for maxillary antral mucocoele.

A 40-year-old female presented with a 10 year history of left sided facial pain and occasional purulent nasal discharge, refractory to antibiotics. Dental examination showed 3 missing teeth in left maxilla one of which had no history of extraction. X-ray paranasal sinus showed a bony opacity in the maxillary sinus but nasal endoscopy was normal. C.T. scan revealed a radio-opaque shadow arising from medial wall of left maxillary sinus with a large maxillary mucocoele. Caldwell-Luc procedure was done and an ectopic canine tooth was seen arising from the medial antral wall. Extraction of the tooth with excision of mucocoele resulted in relieving of the symptoms.

Obstrucción del vaciamiento gástrico secundario a heterotopia pancreática en el antro / Gastric Emptying Obstruction Secondary to Pancreatic Heteropathy in Antrum

La heterotopia pancreática (HP) es una lesión relativamente infrecuente, observada con mayor frecuencia en el estómago. En la mayoría de los casos laHP es asintomática, pero puede ocasionalmente acompañarse de dispepsia y hemorragia gastrointestinal superior. Se describe el caso de un hombre de 40 años de edad con obstrucción del vaciamiento gástrico, secundario a HP en el antro.

Heterotopic pancreas (HP) is a relatively infrequent lesion most often found in the stomach. In the majority of cases, HP does not cause symptoms, but it can occasionally present as dyspepsia and upper gastrointestinal bleeding. This report describes the case of a 40-year-old man with gastric outlet obstruction resulting from HP in gastric antrum.

Ectopic pancreas as a cause of gastric outlet obstruction in an infant.

We report a one-month-old male child who presented with clinical and radiological features of gastric outlet obstruction. Surgical exploration showed presence of a prepyloric mass; histological examination of the resected specimen confirmed presence of ectopic pancreatic tissue. The child is well 8 months later.

Lingual thyroid causing dysphonia: case report

CONTEXTO: Tireóide lingual é uma entidade rara, devida a falha na migração da glândula em sua fase embriogênica. A presença da glândula tireóide na base da língua pode acarretar sérios problemas aos pacientes, como disfagia e disfonia, obstrução de vias aéreas superiores e até hemorragia, em qualquer fase da vida. RELATO DE CASO: Apresentamos um caso de tireóide lingual em paciente de 41 anos de idade, discutindo-se a embriogênese, diagnóstico e conduta adequada para tratamento. Elementos para o diagnóstico e avaliação terapêutica são descritos com especial atenção aos achados clínicos, testes laboratoriais, além de metodologia de imagem como medicina nuclear e tomografia computadorizada, realizados para confirmação diagnóstica e planejamento da melhor conduta operatória. A excisão cirúrgica da tireóide ectópica é reservada para casos de aumento glandular, que podem resultar em disfunção das vias aéreas superiores (disfonia ou disfagia), além de hemorragia recorrente.

Experience of an Abdominal Aortic Aneurysm in a Patient Having Crossed Ectopia with Fusion Anomaly of the Kidney

We report a case of surgically treated abdominal aortic aneurysm (AAA) in a patient having crossed ectopia with fusion anomaly of the kidney. One artery from the abdominal aorta above the aneurysm supplies the right kidney while three renal arteries (two from the aneurysm itself and one from the left common iliac artery) supply the crossed ectopic kidney. Preoperative imaging to define the arterial and collecting systems along with a detailed planning of the operation is essential to prevent ischemic renal injury as well as ureteral injury during AAA repair.

Mediastinal enteric duplication cyst containing aberrant pancreas.

OBJECTIVE: The purpose of the study is to report a unique association of clinical and pathological findings in a neonate. Foregut enteric duplication cysts--rare developmental anomalies that are associated with midline vertebral fusion anomalies. METHODS: We had a neonate with foregut duplication cyst who presented at birth with respiratory distress. The child also had associated communicating hydrocephalus. The patient underwent excision of the duplication cyst along with a ventriculo-peritoneal shunt. RESULT: The excised specimen revealed a duplication cyst lined by aberrant pancreatic tissue. CONCLUSION: The present case demonstrates histologically the presence of both pancreatic and gastric tissue.

Tracheo-bronchial remnants: a rare cause of dysphagia.

A 14-year-old girl presented with dysphagia since the age of one year. Investigations revealed two strictures at the lower esophagus. Endoscopic mucosal biopsy from the strictures showed pseudostratified columnar epithelium suggesting that tracheobronchial remnants was the cause of the stenosis. Esophageal dilatation failed to relieve her symptoms.