Tumor neuroectodérmico maligno del tracto gastrointestinal: a propósito de un caso / Malignant neuroectodermal tumor of the gastrointestinal tract: case report

El tumor neuroectodérmico maligno del tracto gastrointestinal es una neoplasia rara con pocos casos reportados en la literatura, especialmente en América Latina. Descrito por primera vez en 2003, se trata de una entidad sin tratamiento estandarizado y de pobre pronóstico. Se presenta el caso de una paciente de 22 años de edad que acude a la consulta por dolor abdominal, anemia y masa abdominal palpable. Luego de estudios pertinentes se decide la conducta resectiva y el posterior tratamiento oncológico. (AU)

Malignant gastrointestinal neuroectodermal tumor (GNET), formerly known as clear cell sarcoma of the gastrointestinal tract, is an extremely rare tumor of mesenchymal origin, which presents great microscopic and molecular similarity to clear cell sarcoma found in other parts of the body, such as tendons and aponeurosis. It is characterized by its rapid evolution, high recurrence rate and frequent diagnosis as metastatic disease.1,2 (AU)

Application of artificial neural network algorithm in pathological diagnosis and prognosis prediction of digestive tract malignant tumors / 浙江大学学报·医学版

The application of artificial neural network algorithm in pathological diagnosis of gastrointestinal malignant tumors has become a research hotspot. In the previous studies, the algorithm research mainly focused on the model development based on convolutional neural networks, while only a few studies used the combination of convolutional neural networks and recurrent neural networks. The research contents included classical histopathological diagnosis and molecular typing of malignant tumors, and the prediction of patient prognosis by utilizing artificial neural networks. This article reviews the research progress on artificial neural network algorithm in the pathological diagnosis and prognosis prediction of digestive tract malignant tumors.

CARACTERIZAÇÃO DAS ENDOSCOPIAS DIGESTIVAS ALTAS REALIZADAS NO MUNICÍPIO DE MOSSORÓ-RN / CHARACTERIZATION OF HIGH DIGESTIVE ENDOSCOPIES PERFORMED IN THE MUNICIPALITY OF MOSSORÓ-RN

Objetivou-se caracterizar as EDA realizadas na Comunidade de Saúde de Mossoró, RN, no período de 2008 a 2013, definindo a taxa de exames normais e a prevalência dos principais achados sugestivos de patologias digestivas. Trata-se de um estudo transversal e retrospectivo, no qual se analisou 10311 laudos de EDA. As análises estatísticas foram realizadas pelo SPSS (Statistical Package for the Social Sciences, versão 20.0), com nível de confiança95% e um p < 0,05, utilizando-se testes Qui-quadrado. Pelos dados levantados, constatamos que a EDA é um exame prático e seguro, com raríssimas complicações, sendo a agitação e a presença de alimento no estômago as limitações mais comuns. Na análise descritiva geral observou-se que a maioria dos exames foi realizada no gênero feminino, formando mais de 70% da amostra total. A faixa etária predominante, independente do gênero, foi 41 a 60 anos. As patologias frequentes no segmento esofágico foram as Esofagites. No segmento gástrico, a maior frequência de achados foram as Gastrites, que são mais frequentes com o avançar da idade. Na Transição Gastroduodenal, as úlceras de Canal Pilórico são os achados mais descritos, mas observamos também modestos achados de duodenites. No duodeno, os principais achados foram úlceras duodenais, seguidas pelas duodenites e sinais de atrofia. Portanto, as EDA são mais realizadas no gênero feminino, mas apresentam maior percentual de exames normais, sendo a maior frequência de achados encontrada no gênero masculino. Assim, após analisar as 10.311 EDA, é possível prever os achados mais comuns encontrados a EDA.

This study aimed to characterize the EDA held in Mossoro Health Community, RN, from 2008 to 2013, setting the rate of normal examinations and the prevalence of the main findings suggestive of digestive pathologies. It is a cross-sectional retrospective study, which analyzed 10,311 reports of EDA. Statistical analyzes were performed using SPSS (Statistical Package for Social Sciences, version 20.0), with a confidence level 95% and p <0.05, using chi-square tests. Raised by the data, we found that EDA is a practical and safe exam, with very few complications, agitation and presence of food in the stomach the most common limitations. In general descriptive analysis it was observed that most of the exams was held in females, forming more than 70% of the total sample. The predominant age group, regardless of gender, was 41-60 years. The frequent pathologies in esophageal segment were Esophagitis. Gastric segment, the highest frequency of findings were Gastritis, which are more common with advancing age. Gastroduodenal in Transition, the Channel Pyloric ulcers are the most described findings, but also observed modest findings of duodenitis. In the duodenum, the main findings were duodenal ulcers, followed by duodenitis and signs of atrophy. Therefore, the EDA are more performed in females, but have a higher percentage of normal results, with the highest frequency of findings found in males. So after analyzing 10,311 EDA, it is possible to predict the most common findings EDA.

Extensión tumoral intraoperatoria radioguiada en cáncer gastrointestinal con alta expresión de receptor del factor de crecimiento epidérmico / Tumor Extent during Radioguided Surgery in Gastrointestinal Cancer with High Expression of Epidermal Growth Factor Receptor

RESUMEN Con el auge contemporáneo de novedosos paradigmas en las ciencias médicas, como la Medicina personalizada, se busca una resección oncológica más eficaz, con nuevos márgenes quirúrgicos de acuerdo al estadio tumoral. Para alcanzar estos resultados, se abren paso técnicas como la cirugía radioinmunoguiada. En Cuba, los adelantos biotecnológicos han permitido el desarrollo de fármacos líderes en el mundo, como el Nimotuzumab, un anticuerpo monoclonal dirigido contra el receptor del factor de crecimiento epidérmico, sobrexpresado en múltiples tumores malignos de origen epitelial. Al marcarlo con un radioisótopo puede auxiliar al cirujano en la determinación precisa de la extensión tumoral (radioguiada) de estas neoplasias durante el acto quirúrgico(AU)

ABSTRACT The contemporary rise of new paradigms within medical sciences, such as personalized medicine, a more effective oncological resection is pursued, with new surgical margins based on tumor stage. To achieve these outcomes, some techniques, such as radioimmunoguided surgery, are expanding. In Cuba, biotechnological advances have allowed the development of world-leading drugs, such as nimotuzumab, a monoclonal antibody directed against the epidermal growth factor receptor, overexpressed in multiple malignant tumors of epithelial origin. Marking it with a radioisotope can help the surgeon in the precise determination of tumor extent (radioguided) of these malignancies during the surgical act(AU)

Primary nonlymphoid gastrointestinal neoplasms in dogs in Rio Grande do Sul / Neoplasmas gastrointestinais primários não linfoides em cães no Rio Grande do Sul

Gastrointestinal neoplasms (GIN) are uncommon in dogs, but they mainly show malignant behavior and poor prognosis. The types of GIN in dogs and their frequency, as well as their epidemiological and histopathological characteristics were analyzed through a retrospective study of biopsies from 24.711 dogs from 2005 to 2017. Additionally, histological sections of neoplasms were subjected to immunohistochemistry (IHC) using antibodies against pancytokeratin, vimentin, smooth muscle actin, c-Kit, S-100, CD31, CD79αcy, and neuron-specific enolase. Of the total samples from dogs analyzed, 88 corresponded to GIN. Neoplasms occurred more frequently in purebred dogs (64.8%, 57/88), males (53.4%, 47/88), with a median age of 10 years. The intestine was affected by 84.1% (74/88) of the cases. Of these, the large intestine was the most affected (67.6%, 50/74). Most of the neoplasms had malignant behavior (88.6%, 78/88). Regarding the classification of neoplasms, 46.6% (41/88) of the diagnoses corresponded to epithelial, 46.6% (41/88) were mesenchymal, 5.7% (5/88) were hematopoietic, and 1.1% (1/88) was neuroendocrine. The most frequently diagnosed neoplasms were papillary adenocarcinoma (19.3%, 17/88), leiomyosarcoma (17.0%, 15/88), gastrointestinal stromal tumors (GISTs) (12.5%, 11/88), and leiomyoma (5.0%, 8/88). Adenocarcinomas were located mainly in the rectum, whereas leiomyosarcomas and GISTs developed mainly in the cecum. Epithelial neoplasms showed a greater potential for lymphatic invasion whereas mesenchymal neoplasms appeared to be more expansive with intratumoral necrosis and hemorrhage. Immunohistochemistry was found to be an important diagnostic technique for the identification of infiltrating cells in carcinomas and an indispensable technique for the definitive diagnosis of sarcomas.(AU)

Neoplasmas gastrointestinais (NGI) são pouco comuns em cães, mas possuem principalmente comportamento maligno e prognóstico reservado. Os tipos de NGI em cães e sua frequência, bem como características epidemiológicas e histopatológicas foram analisados por meio de um estudo retrospectivo dos exames de biópsias de 24.711 cães entre os anos de 2005 a 2017. Adicionalmente, cortes histológicos de NGI foram submetidos à técnica de imuno-histoquímica (IHQ), utilizando os anticorpos anti-pancitoqueratina, vimentina, actina de músculo liso, c-Kit, S-100, CD31, CD79αcy e enolase neurônio específica. Do total de cães analisados, 88 corresponderam a NGI não linfoides. Os neoplasmas ocorreram com maior frequência em cães de raça pura (64,8%, 57/88), machos (53,4%, 47/88), com mediana de idade de 10 anos. O intestino foi acometido em 84,1% dos casos (74/88). Destes, o intestino grosso foi o segmento mais afetado (67,6%, 50/74). A maior parte dos neoplasmas tinha comportamento maligno (88,6%, 78/88). Quanto à classificação, 46,6% (41/88) dos diagnósticos corresponderam a neoplasmas epiteliais, 46,6% (41/88) mesenquimais, 5,7% (5/88) hematopoiéticos e 1,1% (1/88), neuroendócrino. Os neoplasmas mais frequentemente diagnosticados foram adenocarcinoma papilar (19,3%, 17/88), leiomiossarcoma (17,0%, 15/88), tumor estromal gastrointestinal (GIST) (12,5%, 11/88) e leiomioma (12,5%, 8/88). Adenocarcinomas localizavam-se principalmente no reto, enquanto leiomiossarcoma e GISTs desenvolveram-se principalmente no ceco. Os neoplasmas epiteliais demonstraram um potencial maior de invasão linfática enquanto que os mesenquimais aparentaram ser mais expansivos, com necrose e hemorragia intratumorais. A imuno-histoquímica mostrou ser uma técnica diagnóstica importante para a identificação de células neoplásicas infiltravas no caso dos carcinomas e uma técnica indispensável para o diagnóstico definitivo de sarcomas.(AU)

Páncreas ectópico, diagnóstico diferencial de lesión gástrica subepitelial: reporte de caso y enfrentamiento inicial / Ectopic pancreas, differential diagnosis of subepithelial gastric lesion: case report and initial confrontation

Subepithelial lesions are generally an incidental diagnosis with an prevalence of 0.4%. These tumors represent a great diagnostic challenge, mainly when ruling out potentially malignant lesions, such as gastrointestinal stromal tumor (GIST), lymphomas and carcinomas. Among the many differential diagnosis, the ectopic pancreas arises with an prevalence of 1-2% in general population. The first diagnostic approach is performed using upper digestive endoscopy, computed tomography and endosonography. This last one has a diagnostic performance of less than 50%, which increases to 90% when it is associated with a histopathological examination. There is no current consensus regarding the management and monitoring of these lesions. Based on the imaging and histological characteristics, the possibilities range from observation to endoscopic or surgical resection. In this context, we will present a clinical case of ectopic pancreas as an incidental finding, and afterwards the diagnostic and therapeutic breakdown of subepithelial lesions.

Las lesiones subepiteliales son pesquisadas generalmente de manera incidental, con una prevalencia de 0,4%. Estos tumores suponen un gran desafío diagnóstico, principalmente al momento de descartar lesiones potencialmente malignas, como el tumor estromal gastrointestinal (GIST), linfomas y carcinomas. Dentro de los posibles diagnósticos, surge el páncreas ectópico, con una prevalencia de hasta 1-2% en la población general. La primera aproximación diagnóstica se realiza mediante endoscopia digestiva alta, tomografía computarizada y la endosonografía, ésta última con un rendimiento diagnóstico menor del 50%, que aumenta hasta el 90% al asociar el examen histopatológico. No existe consenso actual respecto al manejo y seguimiento de estas lesiones, que según sus características imagenológicas e histológicas, va desde la observación hasta la resección endoscópica o quirúrgica. En este contexto, se presenta un caso clínico de páncreas ectópico como hallazgo incidental y el desglose diagnóstico y terapéutico de las lesiones subepiteliales.

Laparoscopy in gastro- intestinal tumors

Background: Cancer is a major public health problem worldwide. Many studies have shown that the completion of adjuvant chemotherapy improves the survival rate. Objectives: The aim of the current study was to discuss the efficacy and role of diagnostic and therapeutic laparoscopy as a new trend in managing gastrointestinal tumors. Patients and Methods: This prospective study included a total of 50 patients, whom had gastro-intestinal tumor diagnosed by tissue biopsy and histopathology attending at General Surgery Department, Sayed Galaal Al-Azhar University Hospital. The hospital statistically significant data for the included 50 patients, pre and post diagnostic laparoscopy and surgical intervention were collected and analyzed. Results: A significant percentage of intra-abdominal cancers prove to be inoperable because of metastatic or locally advanced disease despite a preoperative workup suggesting a potentially resectable disease. Conclusion: It could be concluded that diagnostic laparoscopy is accurate staging tool for gastro intestinal tumors as staging method prior to surgery that can change plan to start neoadjuvant chemotherapy (CTR) instead of surgery. Laparoscopic surgery shows also short post- operative patient stay at hospital and early start of CTR

Duodenectomía parcial distal con conservación del páncreas por un tumor del estroma gastrointestinal / Distal partial duodenoscopy with pancreas conservation for stromal gastrointestinal tumor

Los tumores del estroma gastrointestinal son los tumores mesenquimatosos más frecuentes del sistema digestivo. En el duodeno son raros, con menos de 5 por ciento. A diferencia de los carcinomas, los tumores del estroma gastrointestinal no infiltran la mucosa de manera extensa. La resección quirúrgica con bordes de sección negativos sin linfadenectomía es el principal tratamiento con intención curativa y las resecciones conservadoras se llevan a cabo siempre y cuando sean factibles desde el punto de vista técnico. Presentamos una paciente con un tumor del estroma gastrointestinal de duodeno cuya principal manifestación fue el sangrado digestivo alto. La lesión fue resecada con bordes de sección quirúrgicos negativos mediante una duodenectomía parcial distal de la tercera y cuarta porciones del duodeno con preservación del páncreas. El tránsito intestinal fue restituido mediante una duodenoyeyunostomía término-terminal en un plano de sutura. En este momento, la paciente recibe tratamiento con metisilato de imatinib(AU)

Gastrointestinal stromal tumors are the most frequent mesenchymal tumors of the digestive system. In the duodenum, their presentation is rare, with less than 5 persent. Unlike carcinomas, gastrointestinal stromal tumors do not extensively infiltrate the mucosa. Surgical resection with negative section borders without lymphadenectomy is the main treatment with curative intent, and conservative resections are carried out as long as they are feasible from the technical point of view. We present the case of a patient with a gastrointestinal stromal tumor of the duodenum and whose main manifestation was high digestive bleeding. The lesion was resected with negative surgical section borders through a distal partial duodenectomy of the third and fourth portions of the duodenum and with preservation of the pancreas. The intestinal transit was restored by a terminal duodenojejunostomy in a suture plane. At this time, the patient is treated with imatinib mesylate(AU)

Primary cutaneous amelanotic melanoma and gastrointestinal stromal tumor in synchronous evolution

Abstract: Gastrointestinal stromal tumor is rare digestive tract mesenchymal tumor, most often in the wall of the stomach. It is a benign neoplasm, but it can become malignant if not treated. We report a case of gastrointestinal stromal tumor that was discovered after abdominal ultrasonography during staging of a patient with primary cutaneous amelanotic melanoma. Mutation in the tyrosine kinase receptor could explain the development of two types of tumors in the same patient.

Tumores del estroma gastrointestinal: Análisis de 40 casos / Gastrointestinal stromal tumors. Analysis of 40 cases

Los tumores del estroma gastrointestinal representan menos del 3% de los tumores digestivos. Se localizan principalmente en el estómago y el intestino delgado. El tratamiento radical es la resección quirúrgica. Cuando son inoperables o diseminados la administración de imatinib es el tratamiento de elección. La finalidad de este estudio retrospectivo fue describir las características de los pacientes con tumores del estroma gastrointestinal atendidos en nuestra institución en el período 2000-2015. Fueron analizados los casos de 40 pacientes consecutivos con diagnóstico de tumor del estroma gastrointestinal (edad media 58 años, rango 33-84). La supervivencia media a 5 años del total de pacientes fue 30.5%. Al diagnóstico, 30 (75%) tenían enfermedad localizada; de estos, 14 recibieron imatinib adyuvante y 15 seguimiento en observación. En este grupo, el intervalo libre de enfermedad fue 55 meses. En aquellos con enfermedad diseminada, el intervalo libre de progresión fue 30 meses.

Gastrointestinal stromal tumors represent less than 3% of all digestive tumors. They are primarily located in the stomach and the small intestine. The curative treatment is surgical resection. In the case of unresectable tumor or advanced disease, imatinib is the treatment of choice. The purpose of this retrospective study was to describe the characteristics of patients with gastrointestinal stromal tumors treated at our institution in the period 2000-2015. We analyzed 40 consecutive patients diagnosed with gastrointestinal stromal tumor (mean age 58-year old, range 33-84). The mean 5-year survival was 30.5%. At diagnosis, 30 patients had localized disease (75%); 14 of them received adjuvant imatinib and 15 follow-up on observation. In this group the disease-free interval was 55 months. In patients with advanced disease, the progression-free interval was 30 months.

Colonic basidiobolomycosis with liver involvement masquerading as gastrointestinal lymphoma: a case report and literature review

Abstract Basidiobolomycosis is an unusual fungal skin infection that rarely involves the gastrointestinal tract. This study reported a 5-year-old boy with gastrointestinal basidiobolomycosis that had been misdiagnosed as gastrointestinal lymphoma. He was treated by surgical resection and a combination of posaconazole and amphotericin B deoxycholate with an acceptable response and no recurrence.

Gastrectomía atípica laparoscópica en el tratamiento de GIST gástrico: Resultados a corto y mediano plazo / Laparoscopic atypical gastrectomy in the treatment of gastric GIST. Short-term and medium-term outcomes

Los tumores gastrointestinales del estroma son las neoplasias mesenquimatosas más frecuentes del tracto gastrointestinal. Numerosas investigaciones se han dirigido al tratamiento laparoscópico de los mismos. El propósito de este estudio es evaluar la seguridad y la eficacia de las gastrectomías atípicas en un hospital de alta complejidad de nuestro medio. En el período comprendido entre enero 2009 y diciembre 2015, 24 pacientes con sospecha de GIST gástrico fueron intervenidos quirúrgicamente vía laparoscópica, considerándose criterio de inclusión la ausencia de metástasis hepáticas y peritoneales a distancia, el tamaño tumoral < 5 cm de diámetro y la positividad del antígeno CD117 en los estudios inmunohistoquímicos. Se analizaron retrospectivamente las características clínico-patológicas, los resultados quirúrgicos, las complicaciones postoperatorias y los resultados oncológicos. Fueron incluidos en el estudio estadístico 14 pacientes. La edad promedio fue 60 años (10 mujeres y 4 hombres) y la hemorragia digestiva alta fue la sintomatología de diagnóstico más frecuente. El tiempo promedio de cirugía fue 113 minutos, con necesidad de conversión en un caso. No se registraron complicaciones mayores, reintervenciones ni reinternaciones. El tamaño tumoral promedio fue 41 mm, con márgenes quirúrgicos libres de enfermedad. El promedio de internación fue 3 días y el de seguimiento 44 meses, sin registro de recidivas tumorales. El abordaje laparoscópico a través de gastrectomías atípicas del GIST gástrico resultó una técnica segura y eficaz con buenos resultados a corto y mediano plazo en manos de cirujanos con experiencia.

Gastrointestinal stromal tumors are the most common mesenchymal neoplasms of the gastrointestinal tract. Recently, many studies have addressed the laparoscopic management of these tumors. The aim of this study was to evaluate the safety and efficacy of laparoscopic atypical gastrectomy in the resolution of these neoplasms. In the period between January 2009 and December 2015, 24 patients with suspected gastric GIST less than 5 cm in size underwent surgery under this approach. Abscense of peritoneal and liver metastases and immunohistochemistry expression of CD117 antigen were considered as inclusion criteria. We retrospectively analyzed clinical and histopathological characteristics, surgical outcomes, postoperative complications and oncological results. Statistical analysis included 14 patients. The mean age was 60 years (10 women and 4 men) and upper gastrointestinal bleeding was the chief complaint for consultation. Conversion to open surgery was necessary in one case and no major complications, readmissions or reoperations were recorded. The mean tumor size was 41 mm with negative resection margin in all samples. The mean hospital stay was 3 days and no tumor recurrences were recorded in 44 months of follow-up. Laparoscopic atypical gastrectomy for gastric GIST is a safe and effective technique with good outcomes in experienced hands.

The importance of clinical, histopathological and immunohistochemical marking for differential diagnosis of non-hematopoietic gastrointestinal mesenchymal neoplasms in dogs: literature review / Importância da avaliação clínica, anatomopatológica e imuno-histoquímica para o diagnóstico diferencial das neoplasias mesenquimais gastrointestinais não hematopoiéticas em cães: revisão de literatura

Gastrointestinal neoplasms in dogs represent a challenge for the veterinary clinician and surgeon as they are mostly malignant and when the owner notices the primary clinical changes the disease may already be in an advanced stage. Due to the high clinical and histopathological similarity between mesenchymal gastrointestinal neoplasms, it is often impossible to establish the definitive morphological diagnosis using light microscopy alone. In addition, there are only a few articles describing the anatomopathological and immunohistochemical characteristics, which make its complete characterization urgent and relevant in our context in order to assist the veterinary clinician, surgeon, and pathologist in establishing a precise diagnosis of these tumors.(AU)

As neoplasias gastrointestinais em cães representam casos desafiantes ao clínico e cirurgião, pois são em sua maioria malignas e, quando as primeiras alterações clínicas são notadas pelo proprietário do animal, a doença pode estar em estágio de desenvolvimento muito avançado. Devido à elevada similaridade clínica e histopatológica entre as neoplasias gastrointestinais mesenquimais, muitas vezes não é possível estabelecer o diagnóstico morfológico definitivo apenas com a microscopia de luz. Acrescenta-se que são poucos os artigos que descrevem as características anatomopatológicas e imuno-histoquímicas das neoplasias mesenquimais gastrointestinais que acometem os cães, o que torna premente a caracterização destas em nosso contexto, com o intuito de auxiliar clínico, cirurgião e patologista veterinário a estabelecer o diagnóstico destes tumores.(AU)

Colonoscopy in the diagnosis of acute lower gastrointestinal bleeding / A colonoscopia no diagnóstico da hemorragia digestiva baixa aguda

Lower gastrointestinal bleeding is defined as a bleeding originated from a source distal to the Treitz ligament and the colonoscopy is well established as the diagnostic procedure of choice. Objective: To evaluate the results of colonoscopies performed to diagnose the cause of acute lower gastrointestinal bleeding in a general hospital at Mato Grosso do Sul. Material and methods: Colonoscopy procedures performed in the Endoscopy service of the Hospital Regional de Mato Grosso do Sul in those patients admitted due to an acute lower gastrointestinal bleeding from January 2014 to December 2015 were analyzed retrospectively. The studied variables were age, gender, diagnosis and localization of the lesion. Results: The mean age was 66 years, and there was a little predominance of the male gender. Diverticular disease was the main cause of lower gastrointestinal bleeding in this study, followed by cancer, inflammatory gastrointestinal disease, polyps, and angiodysplasia. Conclusion: The colonoscopy showed to be an effective diagnostic method in the case of acute lower gastrointestinal bleeding and a good therapeutic tool in the case of diverticular disease and angiodysplasia.

Hemorragia digestiva baixa é definida como sangramento originado de uma fonte distal ao ligamento de Treitz e a colonoscopia esta bem estabelecida como o seu procedimento diagnóstico de escolha. Objetivo: Avaliar os resultados das colonoscopias realizadas para elucidação diagnóstica dos casos de Hemorragia digestiva baixa aguda em um Hospital Geral de Mato Grosso do Sul. Materiais e métodos: Foram analisadas, de forma retrospectiva, as colonoscopias realizadas nos pacientes internados devido à hemorragia digestiva baixa aguda, no período de janeiro de 2014 a dezembro de 2015, no serviço de endoscopia digestiva do Hospital Regional de Mato Grosso do Sul. As variáveis estudadas foram a idade, sexo, diagnóstico e localização da lesão. Resultados: A média de idade foi de 66 anos, com uma discreta predominância do sexo masculino. A doença diverticular foi a principal causa de hemorragia digestiva baixa nesse estudo, seguido de neoplasias, doença inflamatória intestinal, pólipos e angiodisplasia. Conclusão: A colonoscopia mostrou-se como método efetivo no diagnóstico dos casos de Hemorragia digestiva baixa aguda e como uma boa ferramenta terapêutica também nos casos de angiodisplasia.

Intususcepción gastroduodenal como presentación de un tumor del estroma gastrointestinal gástrico / Gastroduodenal intussusception as a presentation of gastric gastrointestinal stromal tumor

Objetivo Presentar un caso de GIST con presentación clínica poco usual. Caso clínico Presentamos una paciente de género femenino, de 70 años, con 5 días de dolor en hemiabdomen superior y vómitos; se le diagnóstica por TC de abdomen y pelvis con contraste una intususcepción gastroduodenal. Se ingresa a pabellón; confirmando diagnóstico, se realiza gastrectomía subtotal más Y de Roux. La biopsia diferida con inmunohistoquímica confirma un GIST gástrico con 2 mitosis cada 50 campos. Se decide manejo conservador y control anual con endoscopia digestiva alta. Buena evolución.

Aim To present a case of GIST with unusual clinical presentation. Case report We present a 70-year old female patient with 5 days of upper abdominal pain and vomiting, being diagnosed with a gastroduodenal intussusceptions by contrasted CT scan. She was admitted to the operating room, confirming the diagnosis and a subtotal gastrectomy with Roux-en-Y reconstruction was performed. A deferred biopsy with immunohistochemical confirmed GIST with 2 mitoses/50 high-powerfields. Conservative management was proposed and annual control with upper endoscopy decided. Satisfactory evolution.

A Case of Disseminated Intra-abdominal Gastrointestinal Stromal Tumor Managed with Low Dose Imatinib / 대한소화기학회지

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. Imatinib mesylate is recommended as adjuvant therapy for GIST after surgical resection. However, drug-related adverse events are common. A 74-year-old female with metastatic GIST who was managed with imatinib experienced severe adverse events, including skin rashes, tremor, and alopecia, etc. The imatinib dose was reduced and the size of the metastatic GIST continued to decrease and adverse events showed significant improvement.

Resección mixta laparoscópica y endoscópica de un tumor del estroma gastrointestinal de la unión gastroesofágica / Resection of a gastrointestinal stromal tumor of the gastroesophagic junction using a mixed laparoscopic-endoscopic technique

Introduction: The ideal treatment for non-disseminated gastrointestinal stromal tumors (GIST) of the stomach is the local surgical resection. The laparoscopic approach has been validated showing its safety without compromising the oncological principles. The localization on the gastroesophagic junction is a specific situation on gastric GIST, mainly for submucosal tumors arising over the lesser curvature. Wedge resection of these tumors is technically demanding and has been associated to surgical complications and late development of stenosis and gastroesophageal reflux. For these reasons a mixed technique combining endoscopic and laparoscopic approaches has been developed. Herein we report a patient with an endophytic gastric GIST located on the gastroesophageal junction operated on with this technique. Clinical Case: A female 37-years old patient with a submucosal tumor of the gastroesophagic junction was submitted to laparoscopic surgery. During the surgical act the difficulty to continue with the laparoscopic resection became evident and the intragastric resection assisted with endoscopy was undertaken. The technique and the surgical outcomes are described. Conclusion. The intragastric approach for submucosal tumors located over the gastroesophagic junction is safe and relatively simple. This technique is widely described in the medical literature and its indications validated.

Introducción. El tratamiento de elección para los tumores localizados del estroma gastrointestinal (GIST) del estómago es la resección quirúrgica local. Se ha demostrado la seguridad de la técnica laparoscópica sin compromiso de los principios oncológicos. Un problema específico está constituido por los GIST de la unión esófago-gástrica, principalmente los tumores de crecimiento intramural que se localizan en la curvatura menor. La resección en cuña de estos tumores no sólo es técnicamente demandante, sino que se asocia a complicaciones quirúrgicas y al desarrollo de estenosis de la unión gastroesofágica o a reflujo gastroesofágico por la extensa destrucción de la anatomía. Por estas razones se desarrolló una técnica mixta combinando el abordaje laparoscópico y endoscópico. En el presente reporte, describimos el caso de una paciente con un GIST gástrico endofítico de la unión esófago-gástrica que fue operado mediante esta técnica. Caso clínico: Paciente femenino de 37 años de edad, en la que se diagnostica un tumor de la unión esófago-gástrica. Ante la sospecha de un posible GIST gástrico se decide el abordaje laparoscópico, durante la cirugía se evidencia la dificultad de la resección laparoscópica por lo que se intenta la resección intragástrica asistida con endoscopia. Se describe la técnica y los resultados de la cirugía. Conclusiones. El abordaje intragástrico de tumores submucosos de la unión esófago-gástrica es seguro y relativamente simple. Esta técnica se encuentra ampliamente descrita en la literatura y sus indicaciones están validadas.

Tumor fibroso solitário retroperitoneal volumoso / Giant solitary fibrous tumor of retroperitoneum

O tumor fibroso solitário (TFS) é uma neoplasia mesenquimal rara caracterizada pela proliferação de células fusiformes, geralmente acometendo a pleura. É diagnosticado, de modo geral, após estudo anátomo-patológico e por imuno-histoquímica, já que muitas vezes encontra-se em local pouco usual e assemelha-se a outras neoplasias. Relatamos o caso de um paciente de 46 anos com massa retroperitoneal compatível com tumor fibroso solitário de baixo grau (AU)

The sol itary fibrous tumor (SFT) is a rare mesenchymal neoplasm characterized by proliferation of spindle cells, usually affecting the pleura. It is usually diagnosed after pathological study and by immunohistochemistry, as it is often located in an unusual location and resembles other cancers. Here we report the case of a 46-year-old patient with retroperitoneal mass consistent with low grade solitary fibrous tumor (AU)

Tumor del estroma gastrointestinal / Gastrointestinal stroma tumor

El tumor estromal gastrointestinal (GIST) representa menos del 3% de las neoplasias gastrointestinales; sin embargo, es el tumor mesenquimático más frecuente del tracto digestivo. El GIST se caracteriza por la expresión del receptor de factor de crecimiento de tirosina kinasa, CD117, lo que lo diferencia de los otros tumores mesenquimáticos como leiomiomas, leiomiosarcomas, leiomioblastomas y tumores neurogénicos, que no expresan esta proteína. 70-80% de los GIST son benignos, localizándose la mayoría en estómago e intestino delgado (> 90%). Pueden originarse también de cualquier porción del tracto digestivo, así como del mesenterio, omento y retroperitoneo. Los GIST malignos son generalmente de gran tamaño (> a 5 cm), con índice mitótico alto, y pueden dar metástasis a hígado y peritoneo. El tratamiento es la resección quirúrgica; en casos de tumores irresecables, se realiza radioterapia y quimioterapia neoadyuvante. Se presenta un paciente de 43 años, ingresado por presentar dolor en el epigastrio, antecedentes de melena en una ocasión. El ultrasonido, la TAC de abdomen, y la laparoscopia, mostraron la presencia de una tumoración en la segunda porción del duodeno, aproximadamente 10 cm con crecimiento exofitico. Se intervino quirúrgicamente, realizándose pancreatoduodenectomía cefálica de Whipple con conservación del píloro (TraversoLongmire), resecando la totalidad del tumor, los resultados definitivos de anatomía patológica informaron: tumor fusocelular del estroma gastrointestinal (GIST de pared duodenal), con alto potencial de malignidad. Tamaño del tumor 9,5 cm. Índice Mitótico de 9 mitosis por 50 HPF con Inmunohistoquímica positiva para CD117, CD34. A dos años de la intervención presenta una evolución favorable...

Gastrointestinal stromal tumor (GIST) represents less than 3% of gastrointestinal malignancies. However, it is the most common mesenchymal tumor of the digestive tract. GIST is characterized by the expression tyrosine kinase CD117, which differentiates it from other mesenchymal tumors such as leiomyomas, leio-miosarcomas, leiomyoblastoma and neurogenic tumors that do not express this protein. 70-80% of the GIST are benign and located mostly in the stomach and small intestine (> 90%).They can also arise from any portion of the digestive tract, mesentery, omentum and retroperitoneum. Malignant GISTs are usually large (> 5 cm), with a high mitotic index, and it can metastasize to the liver and peritoneum. The treatment is surgical resection. Good results have been reported with tyrosine kinase inhibitor STI571. The treatment is the surgical resection; in cases of surgical resection tumors cannot do it, radiotherapy and chemotherapy is carried out. A 43 year-old patient is presented, admitted to present pain in the epigastrium, melena in an occasion. The ecography, CT scan, and laparoscopic view, showed a tumor in the second portion of the duodenum, approximately 10 cm size. Whipple´s operation was carried out (cephalic pancreatoduodenectomy) with conservation of the pylorus (Traverso-Longmire), resecting the entirely tumor. Final results of pathological anatomy informed: fusocelular tumor of the gastrointestinal estroma (GIST of duodenal wall), with high potential of malignancy. Size of the tumor 9,5 cm, mitotic index of 9 for 50 HPF with high positive for CD117, CD34. Two years later of the intervention he presents a good evolution...