Synchronous gastrointestinal stromal tumors (GIST) and other primary cancers: case series of a single institution experience.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasm affecting the gastrointestinal tract. The incidental occurrence of mesenchymal tumors and other primary tumors has not been well described in literature. OBJECTIVE: The aim of this study was to evaluate the clinical and pathologic features of GIST occurring synchronously with other primary tumors. METHODS: Forty-three patients with diagnosis of GIST treated surgically with curative intent at our institution from 1998 to 2006 were included. The patient clinical data and pathological reports were reviewed. RESULTS: Of the 43 patients, there were 6 (14%) cases of synchronous GIST and other primary tumors discovered as coincidental findings. The synchronous GISTs analyzed were located in the stomach (50%) and small intestine (50%), size ranging from 0.7 to 7.6 cm (median 3.35 cm). Five (83%) of the concurrent primary tumors were from gastrointestinal origin and only one (17%) patient presented with concurrent breast cancer and GIST. The synchronous GISTs immunofenotype shows positivity for CD117 and CD34 (100%), smooth-muscle actin (SMA) (67%), S100 (50%) and desmin (33%). Whereas staining for cytokeratin AE1/AE3 and PDGF were all negative. According to GIST risk category for aggressive behavior three were classified as very low, one intermediate and two high. CONCLUSIONS: The synchronous occurrence of GISTs and other primary neoplasm is not an uncommon entity and usually they are discovery incidentally. Epithelial tumors of the gastrointestinal tract are the most associated with concomitant GISTs. Further studies are required to clarify the molecular and genetic mechanisms of carcinogenesis and progression associating GIST and synchronous tumors.

Lesões císticas do pâncreas / Cystic lesions of the pancreas

As lesões císticas pancreáticas estão sendo reconhecidas com freqüência aumentada e tem se tornado um achado comum na prática clínica devido ao avanço nos métodos diagnósticos e terapêuticos, com conseqüente queda na mortalidade cirúrgica.O objetivo desta revisão é discutir a fisiopatogenia, achados clínicos, conduta diagnostica e bases de tratamento segundo os fatores etiológicos responsáveis pela formação das lesões císticas pancreáticas não-neoplásicas.

Lesões benignas do fígado / Benign lesions of the liver

Os autores apresentam uma revisão bibliográfica das lesões hepáticas benignas, abordando o diagnóstico e a conduta na presença do achado de uma lesão hepática.

Tele-surgery: a new virtual tool for medical education.

The rapid evolution of telecommunication technology has enabled advances to be made in low cost video-conferencing through the improvement of high speed computer communication networks and the enhancement of Internet security protocols. As a result of this progress, eHealth education programs are becoming a reality in universities, providing the opportunity for students to have greater interaction at live surgery classes by means of virtual participation. Undergraduate students can be introduced to new concepts of medical care, remote second opinion and to telecommunication systems, whilst virtually experiencing surgical procedures and lectures. The better access this provides to the operating theater environment, the patient and the surgeon can improve the learning process for students. An analogical system was used for this experimental pilot project due to the benefits of it being low cost with a comparatively easy setup. The tele-surgery lectures were also transmitted to other universities by means of a Pentium 4 computer using open source software and connected to a portable image acquisition device located in the São Lucas University Hospital. Telemedicine technology has proven to be an important instrument for the improvement of medical education and health care. This study allowed health professionals, professors and students to have greater interaction during surgical procedures, thus enabling a greater opportunity for knowledge exchange.

Tumores carcinóides gástricos / Gastric Carcinoid tumor

O carcinóide gástrico é um tumor neuroendócrino raro que tem apresentado um aumento de sua incidência nas últimas décadas, tendo sido apontados fatores que podem estar implicados em sua gênese.

Princípios básicos em cirurgia oncológica / Basic principles in oncology surgery

Os autores apresentam uma revisão dos conceitos básicos vigentes no manejo do paciente cirúrgico oncológico, com enfoque no papel do cirurgião e da terapêutica cirúrgica, dentro de um contexto multidisciplinar.

Colangiocarcinoma / Cholangiocarcinoma

Os autores fazem uma revisão bibliográfica sobre os tumores de vias biliares, os colangiocarcinomas. Apresentam a abordagem diagnóstica e terapêutica, assim como o manejo cirúrgico e as principais implicações da patologia.

Carcinomatose Peritonial / Peritoneal carcinomatosis

Os autores fazem uma revisão bibliográfica sobre carcinomatose peritonial, apresentando as novas tendências terapêuticas, o manejo cirúrgico e as principais implicações da patologia.

Tumor de estroma gastrointestinal (gist) / Gastrointestinal stromal tumor (gist)

Os autores fazem uma revisão bibliográfica dos tumores do estroma gastrointestinal (gist), abordando a incidência, a fisiopatologia, prognóstico e o tratamento.

Complicações em cirurgia hepática / Complications in hepatic surgery

Os autores apresentam uma revisão bibliográfica sobre as complicações mais freqüentes pós-ressecções hepáticas.

Diverticulite de intestino delgado em paciente idoso / Diverticulitis of the small bowel in elderly

Os divertículos de intestino delgado são pseudodivertículos, formados apenas por mucosa. São raros e tem maior incidência em idosos. Em geral, evoluem de forma satisfatória com tratamento conservador. Sua importância clínica é devida a complicações tais como dor abdominal, inflamação ou perfuração, diarréia e/ou má absorção, hemorragia e pseudo-obstrução. Relatamos um caso de diverticulite de intestino delgado, descrevendo suas características clínicas e cirúrgicas (AU)

Small bowel diverticula are pseudodiverticula consisting of mucosa only. They are unusual and have higher incidence in older people. In general, the outcome is satisfactory with conservative treatment. Their clinical relevance is due to complications such as chronic abdominal pain, inflammation or perforation, diarrhea and/or malabsortion, hemorrhage and pseudo-obstruction. We describe a case of diverticulitis of the small bowel with its clinical and surgical characteristics (AU)

Sondas e drenos / Stents and drain

Os autores realizam uma revisão não-sistemática sobre os principais aspectos envolvidos no uso de drenos e sondas em pacientes cirúrgicos, utilizando a base de dados do MEDLINE e revisão da literatura

A síndrome do compartimento abdominal / The abdominal compartment syndrome

Os autores fazem uma revisão bibliográfica sobre a síndrome do compartimento abdominal, suas implicações clínicas e fisiológicas, e seu manejo clínico e cirúrgico

Colangite aguda / Cholangitis acute

A colangite é uma afecção do trato biliar com significativa morbi-mortalidade associada. Muitos pacientes com colangite aguda respondem à antibioticoterapia. Entretanto, aqueles com a forma severa ou tóxica da doença usualmente não respondem, necessitando de drenagem biliar de emergência

Tumores da Papila (Ampola) de Vater / Ampulla of Vater Neoplasms

Os autores fazem uma revisão bibliográfica sobre os tumores da Papila de Vater, sua classificação, apresentação clínica, diagnóstico e estadiamento, assim como as alternativas de procedimentos cirúrgicos

Tumores neuroendócrinos do trato gastrointestinal / Neuroendocrine tumors of the gastrointestinal tract

Os tumores neuroendócrinos (TNE) já foram considerados raridades. Atualmente, através de novas técnicas para seu reconhecimento, tem-se identificado um número crescente destas neoplasias, sendo possível estratificá-las em subgrupos, expandindo o espectro dos neoplasmas neuroendócrinos e sua importância na prática cirúrgica atual. A imunocitoquímica, a dosagem de peptídeos e os modernos métodos de imagem proporcionam informações imprescindíveis para um diagnóstico acurado e o tratamento adequado. Este artigo tem por objetivo revisar aspectos referentes aos tumores neuroendócrinos do trato gastrointestinal relativos à história, fisiopatologia, classificação atualizada, diagnóstico e tratamento

Colangiocarcinoma hilar / Cholangiocarcinoma

Os autores fazem revisão sobre o tumor de Klatskin, abordando, principalmente, aspectos diagnósticos e terapêutica

Tumores não-epiteliais do estômago / Nonepithelial gastric neoplasms

O estômago é, com certa frequência, sede de uma gama de neoplasias, muitas das quais ocorrem em qualquer área da anatomia orgânica. O conhecimento destas afecções, ainda limitado, tem-se ampliado de forma convincente nos últimos anos. Definir as neoplasias não-epiteliais do estômago,benignas e malignas, os tipos histológicos, o diagnóstico e o tratamento é o objetivo deste estudo

Papiloduodenectomia como alternativa terapêutica para tumores papilares / Papiloduodenectomy as an alternative treatment for papillary tumors

The papiloduodenectomy is a procedure that, although accomplished rarely, has its validity in selected cases of papillary tumors. It is included in this group the patients with important diseases that doesn`t have conditions of supporting the surgery of Whipple, the standard procedure for these pathologies. The authors review its experience with four patient carriers of malign neoplasia of the duodenal papila submitted to papiloduodenectomy. All the patients came jaundiced to the admission. The age varied of 62 to 82 years. The ultrassonography, the computed tomography and the endoscopy with biopsy were used for diagnosis and staging, and all the patients presented with initial stages (T1 or T2). Two patients were classified as ASA3 and the other two as ASA4, according to the American Society of Anesthesiology. All the diagnoses were proven by the pathological exam of the surgical piece. It is ended that this procedure facilitates to obtain appropriate margins and satisfactory results when indicated of appropriate way

Carcinoma de pequenas células do esôfago / Small cell carcinoma of the esophagus

Small cell carcinoma of the esophagus is a rare tumor, described to the first time by Mckeown in 1952. Clinically it is very similar to small cell carcinoma of the lung, with quick evolution and early dissemination. It is more frequent in men between 60 and 70 years of age. The patients usually have dysphagia and weight loss. Most of the tumours arise in the middle and distal third of the esophagus. Chronic alcohol and tobacco use are usually present. The manegement of primary small cell cancer of the esophagus remains controversial with groups reporting treatment based on operation alone, local radiotherapy, chemotherapy alone, or operation with adjuvant therapy. Overall survivel remains poor at a mean of 5.1 months, with the best rate of survivel in patients undergoing operation with adjuvant chemotherapy. The authors relate two cases of a small cell carcinoma of the esophagus. Both of these patients was female and white, with 51 and 64 years old. The first mainestation was dysphagia and weight loss. Histologic study from endoscopic biopsies reveled the diagnosis. The treatment was, in the both cases surgery, however in one case, chemotherapy and mediastinal irradiation was associated to the ressection. The authors comment the more important aspects about this pathology, and the treatment and survival of the patients