Linfangioma quístico de recto-sigmoides en un hospital público de Lima, Perú: reporte de caso / Cystic lymphangioma of the rectum-sigmoid in a public hospital in Lima-Peru: case report

RESUMEN Los linfangiomas son lesiones benignas que se deben a una malformación del desarrollo en el sistema linfático que ocurre durante la etapa embrionaria. Son más frecuentes en niños. Pueden encontrarse en cavidad abdominal, siendo la afectación del tracto gastrointestinal en forma ocasional. La presentación clínica es variada, dependiendo de la localización de los linfangiomas, pudiendo tener formas asintomáticas y, en ocasiones, presentarse con dolor abdominal, alteraciones del hábito defecatorio, rectorragia, etc. El diagnóstico se realiza por endoscopía, imágenes auxiliares y se confirma por medio de histología. Presentamos un caso de linfangioma quístico de recto-sigmoides que tuvimos en nuestro hospital; la paciente se presentó con proctalgia, alternancia evacuatoria y rectorragia intermitente. Examen físico sin alteraciones significativas. Durante la colonoscopía, a nivel de recto y sigmoides, se encontró múltiples lesiones protruidas, a modo de protuberancias, cuya superficie era lisa, trasluciente y de coloración azulada, con algunos orificios pseudodiverticulares, a predominio de recto. En la ultrasonografía endoscópica se observó, a nivel del recto, engrosamiento de la submucosa con múltiples imágenes anecoicas, microquísticas, algunas de ellas con tabiques finos. El diagnóstico definitivo se realizó mediante histopatología, que describe conductos linfáticos dilatados, rodeados de células endoteliales, hallazgos consistentes con linfangioma quístico de recto-sigmoides.

ABSTRACT Lymphangiomas are benign lesions due to a developmental malformation in the lymphatic system that occurs during the embryonic stage. They are more frequent in children. They can be found in the abdominal cavity, being the involvement of the gastrointestinal tract occasionally. The clinical presentation is varied, depending on the location of the lymphangiomas, and may have asymptomatic forms and, occasionally, present with abdominal pain, changes in defecation, rectal bleeding, etc. The diagnosis is made by endoscopy, auxiliary images and is confirmed by histology. We present a case of cystic rectal-sigmoid lymphangioma that we had in our hospital; the patient presented with proctalgia, alternating evacuation and intermittent rectal bleeding. Physical examination was without significant alterations. During the colonoscopy, at the level of the rectum and sigmoids, multiple protruded lesions were found, whose surface was smooth, translucent and bluish in color, with some pseudodiverticular holes, predominantly of the rectum. Endoscopic ultrasound revealed thickening of the submucosa at the level of the rectum with multiple anechoic, microcystic images, some of them with fine septa. The definitive diagnosis was made by histopathology, which describes dilated lymphatic ducts, surrounded by endothelial cells, findings consistent with cystic rectal-sigmoid lymphangioma.

Trombosis segmentaria sigmoidea consecuente a neoplasia maligna de colon. A propósito de un caso interesante / Sigmoid segmental thrombosis consequent to colon malignant neoplasia. On the purpose of a case

RESUMEN Se presentó un caso de una paciente de 78 años de edad, procedente del municipio de Calimete, con antecedentes patológicos personales de infarto agudo miocárdico sin elevación del segmento ST e hipertensión arterial. Llegó a la Unidad de Cuidados Intensivos de Emergencia, de Colón con un estado toxico infeccioso severo. Fue intervenida quirúrgicamente con el diagnóstico presuntivo de una trombosis mesentérica. Se constató dicho diagnóstico complementario a una neoplasia maligna de colon sigmoides. Falleció producto a un shock séptico refractario a aminas. En la necropsia se reportaron hallazgos de interés.

ABSTRACT The authors present the case of a 78-years-old female patient from the municipality of Calimete, with personal pathological antecedents of acute myocardial infarct without ST segment elevation and arterial hypertension. She arrived to the Emergency Intensive Care Unit of Colon with a severe toxic-infectious status. She underwent a surgery with a presumptive mesenteric thrombosis. It was stated that diagnosis, complementary to a sigmoid colon malignant neoplasia. She died as a product of an amine-refractory septic shock. The autopsy showed findings of interest.

Sigmoid colon metastasis from hepatocellular carcinoma / 대한간학회지

Hepatocellular carcinoma (HCC) is a major health problem worldwide, and it has a poor prognosis. Extrahepatic metastasis from HCC is not unusual, with direct invasion representing the main spreading mode. Sites that are frequently involved are the lung, bone, and lymph nodes. There are few reports of HCC invading the distant gastrointestinal tract, especially hematogenously. Herein we report a case of sigmoid colon metastasis from HCC. The patient was diagnosed with HCC and treated with transcatheter arterial chemoembolization (TACE). Eighteen months after TACE the patient presented with abdominal pain on the left lower quadrant, and a CT scan showed an enhanced mass on the sigmoid colon. Immunohistochemical staining revealed that a tumor cell was positive for polyclonal carcinoembryonic antigen and weakly positive for hepatocyte antigen, supporting the diagnosis of HCC metastasis. The patient underwent anterior resection for the metastatic HCC.

Intestinal Endometriosis Mimicking Carcinoma of Rectum and Sigmoid Colon: A Report of Five Cases

Among women with intestinal endometriosis, the sigmoid colon and rectum are the most commonly involved areas. Sometimes, the differential diagnosis of colorectal endometriosis from carcinoma of the colon and rectum is difficult due to similar colonoscopic and radiologic findings. From October 2002 to September 2007, we performed five operations with curative intent for rectal and sigmoid colon cancer that revealed intestinal endometriosis. Colonoscopic and radiologic findings were suggestive of carcinoma of rectum and sigmoid colon, such as rectal cancer, sigmoid colon cancer and gastrointestinal stromal tumor (GIST). Anterior resection was performed in two patients, low anterior resection was performed in one patient and laparoscopic low anterior resection was done in two patients. We suggest to consider also intestinal endometriosis in reproductive women presenting with gastrointestinal symptoms and an intestinal mass of unknown origin.

Tumor diverticular que imita una enfermedad neoplásica en un paciente VIH-positivo / Diverticular tumor imitating neoplastic disease in an HIV positive patient

Introducción: A pesar de que en la era de la terapia antirretroviral de alta eficacia (HAART) la incidencia de los tumores malignos en la población VIH/SIDA está en creciente aumento y es actualmente su mayor causa de muerte, estos pacientes también pueden presentar lesiones tumorales de origen inflamatorio, micótico, parasitario, o bacteriano, que en algunos casos puede resultar muy difícil diferenciar de una neoplasia antes de la exéresis quirúrgica completa de la lesión. Objetivo: Comunicar el caso de un paciente VIH-positivo con un tumor inflamatorio de origen diverticular y discutir los posibles diagnósticos diferenciales. Paciente y método: Paciente masculino de 42 años, drogadependiente y VIH positivo (estadio AI), en tratamiento con HAART, con constipación y mucorrea de 4 años de evolución y proctorragia postevacuatoria y dolor abdominal a predominio de FII intermitentes desde hace un año. Examen fisico, laboratorio de rutina, CEA y perfil inmunológico normales. La videocolonoscopía y el colon por enema mostraron una estenosis sigmoidea infranqueable con mucosa conservada. La tomografia computada abdominopelviana evidenció engrosamiento parietal del colon sigmoides y múltiples ganglios no adenomegálicos. Resultados: Se indicó el tratamiento quirúrgico con el diagnóstico de un probable tumor extramucoso benigno, o de bajo grado de malignidad. Se encontró un tumor sigmoideo duro-elástico de 9 x 7 cm, con la serosa congestiva y adherencias laxas a la cara posterior de la vejiga, acompañado por varias adenopatías mesentéricas. Se realizó una resección anterior con carácter oncológico. Abierta la pieza se constató un gran engrosamiento parietal con mucosa edematosa. No tuvo complicaciones postoperatorias. La anatomia patológica informó una enfermedad diverticular del colon con peridiverticulitis y marcada fibrosis parietal. (TRUNCADO) (AU)...

Introduction: Despite the fact that in the highly active antiretroviral therapy (HAART) era the incidence of malignant tumors in HIV/AIDS population is increasing, and is currently the major cause of death, these patients can also present tumoral lesions of inflammatory, fungal, parasitic, or bacterial origin in some cases very difficult to differentiate from a neoplasia before complete surgical resection. Objective: Report on a HIV positive patient with an inflammatory diverticular tumor, and discuss the possible differential diagnosis. Patient and methods: Male, 42 years old, intravenous drug abuser, and HIV-positive (AI stage), on HAART, complaining of constipation and mucous discharge the last 4 years, and intermittent rectal bleeding and abdominal pain (predominantly in the right iliac fossae) the last year. Physical examination, blood tests, CEA, and immune status were normal. Colonoscopy and barium enema showed a not negotiable sigmoid stenosis with normal mucosa. The computed tomography of the abdomen and pelvis showed parietal thickening of the sigmoid colon and multiple not enlarged lymphoid nodes. Results: Surgical treatment, with the diagnosis of probable extramucosal benign or low-grade malignant tumor, was indicated. A 9 x 7 cm, rubber consistency sigmoid tumor was found. It had congestive serosa and smooth adhesions to the posterior aspect of the bladder, associated with several mesenteric nodes. An oncologíc anterior resection was carried out. The opened specimen showed a 4 cm thickening of the intestinal wall, with edematous, non tumoral mucosa. The postoperative course was uneventful. The histopathology report was diverticular colonic disease with peridiverticulitis, and marked parietal fibrosis. Conclusion: Currently, in the HIV-positive population the incidence of malignant tumors related or not to AIDS has increased, due to better management of opportunistic infections, and the best life expectancy... (TRUNCADO)

Streptococcus intermedius liver abscesses and colon cancer: a case report / Abscesos hepáticos por Streptococcus intermedius y cáncer de colon: reporte de un caso

Certain species of bacteria are known to be associated with colorectal cancer. We report a case of adenocarcinoma of the colon with bacteraemia and liver abscesses due to Streptococcus intermedius. The isolation of this organism should prompt investigation for colorectal neoplasm, which may be present but asymptomatic, without metastases, and therefore at a curative stage.

Se sabe que ciertas especies de bacterias están asociadas con el cáncer colorectal. El presente trabajo reporta un caso de adenocarcinoma del colon acompañado de bacteriemia y abscesos hepáticos debidos a Streptococcus del grupo intermedius. El aislamiento de este organismo debe impulsar la investigación del neoplasma colorectal, el cual puede estar hallarse presente pero de forma asintomática, sin metástasis, y por consiguiente en una fase en que la cura es aún posible.

Advanced sigmoid carcinoma colon.

A 13-year-old female child diagnosed initially as having tuberculosis was subsequently found to have adenocarcinoma colon with secondaries in ovaries and omentum, and proved to be mucinous carcinoma on biopsy. Patient received chemotherapy (FAM) regimen without any relief even 2 months after surgery.

Obstrução em alça fechada com ruptura do ceco: aspectos na tomografia computadorizada: relato de um caso / Computed tomography findings in closed obstruction of the small bowel associated with rupture of the cecum: a case report

A obstrução intestinal em alça fechada determina uma situação de extrema gravidade, com conseqüências sérias, podendo por vezes levar ao óbito. Os autores descrevem um caso de obstrução intestinal secundária a câncer no sigmóide, destacando a importância da tomografia computadorizada na análise das alterações patológicas na rotina de abdome agudo

Closed loop obstruction of the bowel is an extremely grave condition that may lead to serious consequences and even be fatal. The authors describe a case of a patient with intestinal obstruction secondary to cancer of the sigmoid and highlight the importance of computed tomography in the analysis of the pathological changes in routine management of patients with acute abdomen.

Adenoma velloso hipersecretante del colon sigmoides / Hypersecretive villous adenoma of the sigmoid colon

Se presenta el caso de una paciente de 41 años portadora de un adenoma velloso (AV) hipersecretante del colon sigmoides que es hospitalizada de urgencia por deshidratación y shock hipovolémico secundaria a una diarrea mucosa de un año de evolución, con falla prerrenal y acidosis metabólica, marcada hipokalemia y baja de peso de 6 kg. Luego de una vigorosa reposición hidroelectrolítica, el estudio de la diarrea reveló la presencia de un tumor velloso de 10 cm en el colon sigmoides, logrando identificarse el AV tanto al enema baritado como a la colonoscopia. Fue sometida en forma electiva a una resección anterior con buena evolución postoperatoria, cesando la diarrea en forma abrupta. El estudio histopatológico de la pieza demostró un adenoma velloso gigante sin displasia

Diffuse cavernous haemangioma of the rectosigmoid with bladder involvement--a case report.

Haemangiomas of large bowel are very rare. We report extensive colonic haemangiomatosis in one young boy affecting bladder, sigmoid colon & descending colon. The patient was managed with sphincter saving operation.

Metástases de origem primária desconhecida: primeira manifestaçäo no tecido ósseo: orientaçäo para o diagnóstico do tumor primário / Skeletal metastasis of unknown origin: first manifestation on the bone tissue: orientation for the diagnosis of the primary tumor

Trinta e sete pacientes que apresentaram metástases ósseas como primeira manifestaçao de carcinoma foram revisados. Uma seqüência simples de diagnóstico consistindo de anamnese cuidadosa, exame físico, testes laboratoriais de rotina, radiografia de tórax, mapeamento do esqueleto com tecnécio e biópsia óssea, identificou o local primário em 17 (45,9 por cento) pacientes. O local primário foi pulmao em oito (21,6 por cento), rim em quatro (10,8 por cento), próstata em dois (5,4 por cento), hepatocarcinoma, tumor de sigmóide e leiomiossarcoma em um (2,7 por cento) paciente. Com base nessa estratégia, propusemos um algoritmo que, associado aos testes imuno-histoquímicos e à utilizaçao de marcadores tumorais, deverá aumentar o índice de diagnóstico da origem primária dessas metástases.

Rectosigmoid lipoma an unusual colonic lipoma. Case report and review of the literature

This is a case report of a male patient admitted with a huge rectosigmoid mass that had eroded into the lumen, causing persistent rectal bleeding. Special procedures such as double contrast Barium Enema, abdomino-pelvic CT-Scan and proctosigmoidoscopy addressed us to identify it as an intramural lipoma. Rectosigmoid lipoma with its differential diagnosis and surgical approach is reviewed together with the most pertinent literature

Lipoma submucoso del sigmoides con invaginación colorectal / Submucosal lipoma of the sigmoid with colorectal intussusception

Se presentan los hallazgos clínicos, radiológicos, endoscópicos, quirúrgicos y anatomopatológicos de una invaginación colorectal por lipoma submucoso del colon en una paciente de 40 años con síndrome disenteriforme y dolor abdominal; concomitantemente, obstrucción intestinal baja intermitente. Los estudios complementarios revelaron un tumor que ocupaba la luz intestinal y que se desplazaba; unas veces se palpaba en la fosa ilíaca izquierda, para luego desaparecer y encontrarse sólo accesible al tacto rectal. Endoscópicamente llamó la atención el aspecto "nacarado" de la superficie y la firmeza de la lesión. La persistencia de síntomas obstructivos condujo a la intervención quirúrgica encontrándose una invaginación colorectal actuando como cabeza de invaginación, un lipoma submucoso del sigmoides. Se encontró además un infarto segmentario de la pared intestinal. La paciente se recuperó bien y se encuentra libre de síntomas a los cinco meses del postoperatorio

Hemangioma do retpo e sigmóide: apresentaçäo de um caso / Sigmoid and rectum haemangioma: apresentation of a case

Os autores apresentam um caso de hemangioma de reto e sigmóide. Chamam a atençäo pela raridade de patologia e discutem os métodos diagnósticos assim como as diversas etapas no tratamento durante a evoluçäo da doença por 16 anos, que apesar de ser benigna necessita às vezes tratamento bastante agressivo