Thoracic duct lymphangioma and chylous ascites in a 24-year-old female

Lymphangiomas are rare and correspond to 0.7% to 4.0% of mediastinal tumors, and isolated mediastinal location occurs in 1% of cases. They are benign tumors that originate from a congenital malformation of the lymphatic vessels and are diagnosed more frequently in children less than 2 years of age. Chylous ascites is a clinical manifestation of thoracic duct lymphangioma and is composed of lymph accumulation caused by dilation of this lymphatic channel. It appears milky in the peritoneal cavity, containing triglyceride levels higher than 200 mg/dl. We report the case of a young patient with chylous ascites and lymphangioma of the thoracic duct, who was conservatively treated with octreotide and a low-fat diet with medium-chain triglycerides.

Embolização pré operatória no tratamento de paraganglioma abdominal: relato de caso / Pré-operative embolization of abdominal paraganglioma: case report

Paragangliomas is a pheochromocytoma of extra adrenal localization. The case report is a male, 55 years old who presented symptoms of adrenergic hyperstimulation associated to an abdominal mass diagnosed as paraganglioma by a biopsy. Because of its size, localization and vascularization, an aortography with embolization of the nutrient branches of the tumor was done pre-operatively. Four days later, a surgical ressection was performed, and the tumor was adhered to the duodenum, infra-renal aorta and inferior vena cava. We believe that an angiographic study pre-operatively with embolization makes possible an analysis of the anastomosis and arterial supplement, making the ressecability of the tumor safer, although it seems the surgical intervention should have been done earlier.

Tumores cancerosos más frecuentes en pediatría: del oncólogo al pediatra / More frequent cancerous tumors in pediatrics: from oncologist to pediatrician

El rol del pediatra general en el diagnóstico precoz de los diferentes tipos de cáncer que afectan a los niños, es uno de los aspectos que el autor pone en evidencia. A su vez entrega los conocimientos básicos que permiten conocer la situación de los principales avances y la conducta de referencia al especialista. Se trata de un análisis más bien práctico, pues la idea es transmitir su experiencia en el manejo de estas enfermedades, de tal forma que sean de utilidad para el pediatra general, el pediatra con otra especialidad o para el médico general

Lipossarcomas mixioides multicentricos e multifocais sincronicos e metacronicos: relato de caso / Multicenter and multifocal sincronic and metacronic mixoid liposarcomas: case report

Relatamos o caso de um paciente do sexo masculino de 66 anos de idade que apresentou num periodo de seis anos varios lipossarcomas mixoide multicentricos e multifocais sincronicos e metacronicos. Os autores fazem uma revisao das alteracoes citogeneticas e moleculares recentemente descritas na literatura neste tipo de tumor. As alteracoes cromossomicas sao respresentadas pelas translocacoes t (12;16) (q13;p11) e trissomia do cromossomo 8. A analise genica revelou a presenca de fragmentos de restricao alterados devido a diferenca de metilacao especificas e reprodutiveis. Concluem sugerindo que a existencia de multiplos tumores no mesmo paciente sugere a existencia de fator etiologico comum, ainda desconhecido, como sendo o iniciador desta desordem sistemica do tecido gorduroso.

Tratamento de suporte da criança com câncer / Support treatment of children with cancer

O câncer da infância geralmente necessita de tratamento agressivo, que pode causar efeitos indesejáveis como mielossupressao, distúrbios metabólicos e insuficiência renal. Os autores apresentam o caso clínico de um paciente portador de linfoma nao-Hodgkin, com o objetivo de discutir as alteraçoes metabólicas e infecciosas que podem ocorrer durante o tratamento.

Massas abdominais na crianca / Abdominal mass in children

A presenca patologica de aumento de volume de algumas viscera ou de neoformacao na crianca e analisada sob a denominacao generica de "massas abdominais". A maior ou menor incidencia dos principais tumores do recem-nascido ou da crianca maior e seu comportamento benigno ou maligno, em especial daqueles cujo tratamento e eminentemente cirurgico e aqui comentado e discutido. O quadro clinico e os principais exames complementares da investigacao diagnostica dos tumores da crianca sao revisados a luz da literatura

Rhabdomyosarcoma in Thai children.

Twenty-six cases of rhabdomyosarcoma diagnosed from a total of 845 Thai children with childhood malignancy who had been treated at the Department of Pediatrics Ramathibodi Hospital, from May 1970 to December 1982 were analyzed retrospectively. There were 16 boys and 10 girls, aged 3 months to 13 years old (mean age was 5.6 +/- 4.1 years old). The common type was the embryonal cell sarcoma (19 cases), 3 cases were undetermined, 2 cases of alveolar cell type and one each of the pleomorphic and undifferentiated cell type. Only 2 cases had stage II disease, 10 and 14 cases were stage III and IV respectively. The common locations were head and neck (10 cases), abdomen (8 cases including one in the uterus, scrotum and 3 in the urinary bladder), and in 7 cases in the extremities. One patient had small lesion at the buttock. The treatment consisted of surgery, radiation therapy, actinomycin, vincristine and cyclophosphamide. Eight cases were lost to follow-up, 10 cases were discharged in advanced stage after been treated for 6.2 +/- 4 months, 4 cases had no evidence of disease for 2 to 7.5 years, 4 cases died after 4 to 27 months of treatment. The poor result obtained was probably due to the late stages of the disease at diagnosis, and limitations in the use of effective medications.

Tratamento da dor abdominal de origem neoplásica: bloqueio neurolítico do plexo celíaco / Treatment of abdominal pain of neoplastic origin: neurolytic celiac plexus block

Descreve-se a técnica de neurólise alcoólica do plexo celíaco, para o tratamento radical da dor visceral causada por neoplasias primárias ou metastáticas do abdome. Faz-se completa revisäo anatômica do plexo celíaco e seus elementos componentes. Apresentam-se os resultados clínicos obtidos em 78 pacientes oncológicos e 2 näo oncológicos, no período de 3 anos. Conclui-se que, na ausência de invasäo metastática parietal, o bloqueio neurolítico do plexo celíaco é a técnica de eleiçäo para o tratamento da dor oncológica das vísceras abdominais superiores