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1.
Rev Esp Patol ; 56(1): 32-44, 2023.
Article in English | MEDLINE | ID: mdl-36599598

ABSTRACT

Pancreatic cancer and biliary tract cancer have a poor prognosis. In recent years, the development of new diagnostic techniques has enabled the identification of the main genetic alterations involved in the development of these tumours. Multiple studies have assessed the ability to predict response to treatment of certain biomarkers, such as BRCA in pancreatic cancer, IDH1 or FGFR2 in biliary tract cancer and microsatellite instability or NTRK fusions in an agnostic tumour fashion. In this consensus, a group of experts selected by the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Pathology (SEAP) reviewed the role played by these mutations in the process of carcinogenesis and their clinical implications. Based on their results, a series of recommendations are made to optimize the determination of these biomarkers and thus help standardize the diagnosis and treatment of these tumours.


Subject(s)
Biliary Tract Neoplasms , Pancreatic Neoplasms , Humans , Consensus , Biomarkers, Tumor/genetics , Pancreatic Neoplasms/genetics , Medical Oncology , Biliary Tract Neoplasms/diagnosis , Biliary Tract Neoplasms/genetics , Pancreatic Neoplasms
2.
Rev. esp. patol ; 56(1): 32-44, Ene-Mar. 2023. ilus, tab
Article in English | IBECS | ID: ibc-214176

ABSTRACT

Pancreatic cancer and biliary tract cancer have a poor prognosis. In recent years, the development of new diagnostic techniques has enabled the identification of the main genetic alterations involved in the development of these tumours. Multiple studies have assessed the ability to predict response to treatment of certain biomarkers, such as BRCA in pancreatic cancer, IDH1 or FGFR2 in biliary tract cancer and microsatellite instability or NTRK fusions in an agnostic tumour fashion. In this consensus, a group of experts selected by the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Pathology (SEAP) reviewed the role played by these mutations in the process of carcinogenesis and their clinical implications. Based on their results, a series of recommendations are made to optimize the determination of these biomarkers and thus help standardize the diagnosis and treatment of these tumours.


El cáncer de páncreas y el de vías biliares son tumores de mal pronóstico. En los últimos años, el desarrollo de nuevas técnicas diagnósticas de biología molecular ha permitido conocer las principales alteraciones génicas implicadas en el desarrollo de estos tumores. Múltiples estudios han evaluado el carácter predictivo de respuesta a tratamiento de determinados biomarcadores, como BRCA en cáncer de páncreas, IDH1 y FGFR2 en tumores de vía biliar; y la inestabilidad de microsatélites y las fusiones de NTRK, para predecir la respuesta al tratamiento. En este consenso, un grupo de expertos seleccionado por la Sociedad Española de Oncología Médica (SEOM) y la Sociedad Española de Anatomía Patológica (SEAP) ha revisado el papel que desempeñan estas mutaciones en el proceso de carcinogénesis y sus implicaciones clínicas. Como resultado, en este artículo se proponen una serie de recomendaciones para optimizar la determinación de estos biomarcadores, con el fin de fomentar la estandarización en el diagnóstico y el tratamiento de estos tumores.(AU)


Subject(s)
Humans , Medical Oncology , Consensus Development Conferences as Topic , Specialization , Biomarkers, Tumor , Pancreatic Neoplasms , Carcinogenesis , Spain , Pathology , Pathology, Clinical
3.
Clin. transl. oncol. (Print) ; 24(11): 2107-2119, noviembre 2022. ilus
Article in English | IBECS | ID: ibc-210139

ABSTRACT

Pancreatic cancer and biliary tract cancer have a poor prognosis. In recent years, the development of new diagnostic techniques has enabled the identification of the main genetic alterations involved in the development of these tumours. Multiple studies have assessed the ability of certain biomarkers, such as BRCA in pancreatic cancer, IDH1 or FGFR2 in biliary tract cancer and microsatellite instability or NTRK fusions in an agnostic tumour fashion, to predict response to treatment.In this consensus, a group of experts selected by the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Pathology (SEAP) reviewed the role played by these mutations in the process of carcinogenesis and their clinical implications. As a result, this article proposes a series of recommendations to optimize the determination of these biomarkers to help standardize the diagnosis and treatment of these tumours. (AU)


Subject(s)
Humans , Bile Duct Neoplasms/diagnosis , Bile Duct Neoplasms/genetics , Biomarkers, Tumor , Medical Oncology , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/genetics , Consensus
4.
J Dig Dis ; 23(8-9): 455-461, 2022 Aug.
Article in English | MEDLINE | ID: mdl-36168962

ABSTRACT

OBJECTIVES: Non-functioning gastrin-producing neuroendocrine neoplasms (NEN) of the duodenum are rare gastrointestinal tumors without a clinical syndrome due to gastrin production. Their incidence has significantly increased as an incidental finding during endoscopic studies. The aim of this study was to describe the characteristics and prognostic factors of this emergent and infrequent neoplasm. METHODS: We performed a retrospective observational study based on the duodenal NENs samples with positive staining for gastrin at the Department of Pathology, University Hospital 12-de-Octubre (Madrid, Spain) between 2000 and 2017. Patients with clinically functional tumors ([Zollinger-Ellison syndrome] or gastrin >1000 pg/mL), with previously diagnosed multiple endocrine neoplasia (MEN) syndrome or synchronous neoplasia were excluded. Clinicopathological and therapeutic variables, follow-up, recurrence, and mortality data were collected. RESULTS: In all, 21 patients were included. Most of the tumors were diagnosed incidentally as a single small polypoid lesion limited to mucosa/submucosa and with a low histological grade. Four (19.0%) patients presented with metastatic involvement at diagnosis (lymphatic and/or hepatic). These four patients also had a high or intermediate mitotic grade and infiltration further than submucosa. Local resection was applied in most cases as curative treatment. There were two cases of tumor recurrence and two tumor-related deaths with a 5-year disease-free survival of 81.0%. CONCLUSIONS: The majority of these tumors were diagnosed at a localized stage and had a good prognosis with treatment. Nevertheless, given the potential metastatic risk, a close follow-up is necessary, especially in those with aggressive pathological factors such as deep infiltration or high histological grade.


Subject(s)
Duodenal Neoplasms , Neuroendocrine Tumors , Humans , Neuroendocrine Tumors/pathology , Gastrins , Retrospective Studies , Duodenal Neoplasms/surgery
6.
Clin Transl Oncol ; 24(11): 2107-2119, 2022 Nov.
Article in English | MEDLINE | ID: mdl-36008616

ABSTRACT

Pancreatic cancer and biliary tract cancer have a poor prognosis. In recent years, the development of new diagnostic techniques has enabled the identification of the main genetic alterations involved in the development of these tumours. Multiple studies have assessed the ability of certain biomarkers, such as BRCA in pancreatic cancer, IDH1 or FGFR2 in biliary tract cancer and microsatellite instability or NTRK fusions in an agnostic tumour fashion, to predict response to treatment.In this consensus, a group of experts selected by the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Pathology (SEAP) reviewed the role played by these mutations in the process of carcinogenesis and their clinical implications. As a result, this article proposes a series of recommendations to optimize the determination of these biomarkers to help standardize the diagnosis and treatment of these tumours.


Subject(s)
Biliary Tract Neoplasms , Pancreatic Neoplasms , Biliary Tract Neoplasms/diagnosis , Biliary Tract Neoplasms/genetics , Biomarkers, Tumor/genetics , Consensus , Humans , Medical Oncology , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/genetics , Pancreatic Neoplasms
7.
Rev. int. androl. (Internet) ; 20(3): 178-188, jul.-sept. 2022. tab, graf
Article in English | IBECS | ID: ibc-205419

ABSTRACT

Purpose: There is a considerable literature supporting the role of lipids in fertility. However, little is known about their impact on male and female gametes. Our study aimed to investigate the relationships between lipids levels in serum, follicular fluid and seminal plasma with ovarian response and sperm concentration regardless of age and body mass index (BMI).Methods: 51 follicular fluid and serum samples of IVF-ICSI cycles and 52 seminal plasma and serum samples of males in the infertility study were analyzed for cholesterol, triglycerides, and non-esterified fatty acids. The parameters used to assess gonadal response were number of mature oocytes in metaphase II and total motile sperm. Differences between groups were studied by means Principal Component Analysis, Kolmogorov–Smirnov test, Pearson correlation, Student's T, and multivariate linear regression.Results: Using a multivariate linear regression model to exclude the effect of the age and BMI, we found that the lipid profile in follicular fluid and plasma influence inversely and significantly on ovarian response and the number of matured oocytes recovered. Moreover, we found that seminal lipid levels are predictors of seminal quality independent of plasma lipid values.Conclusion: Our current analysis demonstrates the association of low ovarian response and low number of motile sperms with abnormal lipids levels. (AU)


Objetivo: Existen muchas publicaciones que apoyan el papel de los lípidos en la fertilidad. Sin embargo, se sabe poco sobre su impacto en los gametos masculinos y femeninos. Nuestro estudio tuvo como objetivo investigar las relaciones entre los niveles de lípidos en plasma sanguíneo, líquido folicular y plasma seminal con la respuesta ovárica y concentración espermática, independientemente de la edad y el índice de masa corporal (IMC).Métodos: Se analizaron 51 muestras de plasma sanguíneo y líquido folicular de ciclos de FIV-ICSI y 52 muestras de plasma sanguíneo y plasma seminal de varones en estudio de infertilidad para analizar el nivel de colesterol, triglicéridos y ácidos grasos no esterificados. Los parámetros utilizados para evaluar la respuesta gonadal fueron el número de ovocitos maduros y el número total de espermatozoides móviles. Las diferencias entre los grupos se estudiaron mediante la prueba de análisis de componentes principales, la prueba de Kolmogorov-Smirnov, la correlación de Pearson, la T de Student y regresión lineal multivariante.Resultados: Utilizando un modelo de regresión lineal multivariante para excluir el efecto de la edad y el IMC, se encontró que el perfil de lípidos en el líquido folicular y el plasma influyen inversa y significativamente en la respuesta ovárica y el número de ovocitos maduros recuperados. Además, los niveles de lípidos seminales son predictores de calidad seminal independientemente de los valores de lípidos en plasma.Conclusión: Los resultados de este estudio demuestran la asociación de la baja respuesta ovárica y bajo número de espermatozoides móviles con niveles anormales de lípidos. (AU)


Subject(s)
Humans , Male , Female , Young Adult , Adult , Lipids , Oocytes , Semen , Prospective Studies , Fertility , Body Mass Index
8.
Rev Int Androl ; 20(3): 178-188, 2022.
Article in English | MEDLINE | ID: mdl-35599151

ABSTRACT

PURPOSE: There is a considerable literature supporting the role of lipids in fertility. However, little is known about their impact on male and female gametes. Our study aimed to investigate the relationships between lipids levels in serum, follicular fluid and seminal plasma with ovarian response and sperm concentration regardless of age and body mass index (BMI). METHODS: 51 follicular fluid and serum samples of IVF-ICSI cycles and 52 seminal plasma and serum samples of males in the infertility study were analyzed for cholesterol, triglycerides, and non-esterified fatty acids. The parameters used to assess gonadal response were number of mature oocytes in metaphase II and total motile sperm. Differences between groups were studied by means Principal Component Analysis, Kolmogorov-Smirnov test, Pearson correlation, Student's T, and multivariate linear regression. RESULTS: Using a multivariate linear regression model to exclude the effect of the age and BMI, we found that the lipid profile in follicular fluid and plasma influence inversely and significantly on ovarian response and the number of matured oocytes recovered. Moreover, we found that seminal lipid levels are predictors of seminal quality independent of plasma lipid values. CONCLUSION: Our current analysis demonstrates the association of low ovarian response and low number of motile sperms with abnormal lipids levels.


Subject(s)
Follicular Fluid , Semen , Body Mass Index , Fatty Acids, Nonesterified , Female , Humans , Male , Plasma , Spermatozoa
9.
Rev Esp Enferm Dig ; 114(9): 567-568, 2022 09.
Article in English | MEDLINE | ID: mdl-35373571

ABSTRACT

SARS-CoV2 infection and vaccination against this virus have been related to the development of autoimmune diseases. We report a case of autoimmune hepatitis (AIH) after SARS-COV2 vaccine. Male, 76 years old, with a history of hepatic cirrhosis secondary to primary biliary cholangitis (PBC), compensated, treated with ursodeoxycholic acid and obeticholic acid. The patient received the third dose of the SARS-CoV2 vaccine (BioNTech/Pfizer) in December 2021. In subsequent analytical control, the patient presented altered liver test, with elevation of ALT and AST. Ultrasound was performed, without alterations, and viral causes were ruled out. IgG elevation and positive antinuclear antibodies were observed. A liver biopsy was performed, with findings of intense interface and lobular hepatitis and areas of centrilobular necrosis. The inflammation was predominantly lymphoplasmacytic. The patient was diagnosed with AIH and initiated therapy with steroids and azathioprine, currently with an adequate response. AIH is an immune-mediated disease of uncertain etiology. Cases of AIH with SARS-CoV2 vaccination as a possible trigger have recently been published, with characteristics similar to ours. Some of them had a history of autoimmune pathology, such as this case (PBC). Therefore, it is suggested that vaccination can induce the development of autoimmune pathology in patients at risk. Our reported case reinforces the hypothesis of an association between AIH and the SARS-CoV2 vaccine.


Subject(s)
COVID-19 Vaccines , COVID-19 , Hepatitis, Autoimmune , Liver Cirrhosis, Biliary , Aged , COVID-19 Vaccines/adverse effects , Hepatitis, Autoimmune/drug therapy , Hepatitis, Autoimmune/etiology , Humans , Liver Cirrhosis, Biliary/drug therapy , Male , RNA, Viral/therapeutic use , SARS-CoV-2
11.
Rev. esp. enferm. dig ; 111(2): 159-161, feb. 2019. ilus, tab
Article in Spanish | IBECS | ID: ibc-182200

ABSTRACT

La aparición de los nuevos antivirales de acción directa (AAD) para el tratamiento del virus de la hepatitis C (VHC) supone un gran avance para pacientes con hepatitis autoinmune e infectados, ya que hasta el momento no se disponía de opciones terapéuticas libres de interferón. Presentamos el caso de una paciente con infección por VHC que sufrió una HAI desencadenada por interferón, sin conseguir suspender el tratamiento inmunosupresor durante años. Gracias a los AAD, se alcanzó una respuesta viral sostenida y, posteriormente, una remisión clínica completa de su enfermedad autoinmune, sin tratamiento actualmente


The use of direct-acting antivirals (DAA) for the hepatitis C virus (HCV) has yielded a significant improvement in the treatment of autoimmune hepatitis (AIH) associated with HCV infection. Interferon was the cornerstone of HCV therapy before the introduction of these agents into the clinical practice. Herein, we report the case of an HCV-infected patient who developed an interferon-induced AIH and since then, has received immunosuppressive therapy. Administration of DAA resulted in a sustained virologic response (SVR) and clinical AIH remission which allowed a discontinuation of immunosuppressive treatment


Subject(s)
Humans , Female , Middle Aged , Hepatitis C, Chronic/drug therapy , Hepatitis, Autoimmune/drug therapy , Antiviral Agents/therapeutic use , Interferons/therapeutic use , Interferons/adverse effects , Elasticity Imaging Techniques/methods , Liver Cirrhosis/diagnostic imaging
12.
Rev Esp Enferm Dig ; 111(2): 159-161, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30449122

ABSTRACT

The use of direct-acting antivirals (DAA) for the hepatitis C virus (HCV) has yielded a significant improvement in the treatment of autoimmune hepatitis (AIH) associated with HCV infection. Interferon was the cornerstone of HCV therapy before the introduction of these agents into the clinical practice. Herein, we report the case of an HCV-infected patient who developed an interferon-induced AIH and since then, has received immunosuppressive therapy. Administration of DAA resulted in a sustained virologic response (SVR) and clinical AIH remission which allowed a discontinuation of immunosuppressive treatment.


Subject(s)
Antiviral Agents/therapeutic use , Hepatitis C, Chronic/drug therapy , Hepatitis, Autoimmune/drug therapy , Antiviral Agents/adverse effects , Azathioprine/therapeutic use , Benzimidazoles/therapeutic use , Female , Fluorenes/therapeutic use , Hepatitis C, Chronic/complications , Hepatitis, Autoimmune/etiology , Humans , Immunosuppressive Agents/therapeutic use , Interferons/adverse effects , Middle Aged , Prednisone/therapeutic use , Sofosbuvir , Sustained Virologic Response , Uridine Monophosphate/analogs & derivatives , Uridine Monophosphate/therapeutic use
13.
Rev. esp. enferm. dig ; 110(11): 699-705, nov. 2018. tab, graf
Article in English | IBECS | ID: ibc-177908

ABSTRACT

Background and aims: endoscopic submucosal dissection (ESD) in the Western setting remains a challenge. Therefore, other simplified techniques such as knife-assisted snare resection (KAR) have been reported to overcome this issue. Methods: patients who underwent an ESD for the treatment of gastrointestinal neoplasms were included in a retrospective cross-sectional observational study. Factors associated with the end of ESD as a salvage p-KAR were identified and a logistic regression model was developed. Results: a total of 136 lesions in 133 patients were analyzed. Operator experience of under 50 cases and the combination of lesion size > 30 mm and colorectal location were independent predictive factors for switching to a salvage p-KAR according to the multivariate logistic regression analysis. We developed a risk scoring system based on these four variables (experience, size, location and the combination of size and location) with a receiver operating characteristic curve of 0.81 (95% CI: 0.74-0.89). The diagnostic accuracy of the score for a cut-off point ≥ 5 had a sensitivity of 0.79 (95% CI: 0.66-0.93) and a specificity of 0.71 (95% CI: 0.61-0.80). Conclusion: a simple predictive score system that includes four preoperative factors accurately predicts ESD to finish as a p-KAR. A careful selection of cases considering these variables could be useful to achieve better outcomes in the Western setting


No disponible


Subject(s)
Humans , Endoscopic Mucosal Resection/methods , Colorectal Neoplasms/surgery , Stomach Neoplasms/surgery , Treatment Outcome , Margins of Excision , Biopsy/methods , Sensitivity and Specificity , Colorectal Neoplasms/pathology
14.
Rev Esp Enferm Dig ; 110(11): 699-705, 2018 Nov.
Article in English | MEDLINE | ID: mdl-30221971

ABSTRACT

BACKGROUND AND AIMS: endoscopic submucosal dissection (ESD) in the Western setting remains a challenge. Therefore, other simplified techniques such as knife-assisted snare resection (KAR) have been reported to overcome this issue. METHODS: patients who underwent an ESD for the treatment of gastrointestinal neoplasms were included in a retrospective cross-sectional observational study. Factors associated with the end of ESD as a salvage p-KAR were identified and a logistic regression model was developed. RESULTS: a total of 136 lesions in 133 patients were analyzed. Operator experience of under 50 cases and the combination of lesion size > 30 mm and colorectal location were independent predictive factors for switching to a salvage p-KAR according to the multivariate logistic regression analysis. We developed a risk scoring system based on these four variables (experience, size, location and the combination of size and location) with a receiver operating characteristic curve of 0.81 (95% CI: 0.74-0.89). The diagnostic accuracy of the score for a cut-off point ≥ 5 had a sensitivity of 0.79 (95% CI: 0.66-0.93) and a specificity of 0.71 (95% CI: 0.61-0.80). CONCLUSION: a simple predictive score system that includes four preoperative factors accurately predicts ESD to finish as a p-KAR. A careful selection of cases considering these variables could be useful to achieve better outcomes in the Western setting.


Subject(s)
Conversion to Open Surgery , Endoscopic Mucosal Resection , Gastrointestinal Neoplasms/surgery , Aged , Conversion to Open Surgery/instrumentation , Conversion to Open Surgery/statistics & numerical data , Endoscopic Mucosal Resection/statistics & numerical data , Female , Humans , Male , Preoperative Care , Retrospective Studies , Risk Assessment , Treatment Outcome
15.
Rev. esp. enferm. dig ; 110(3): 204-206, mar. 2018. ilus
Article in Spanish | IBECS | ID: ibc-171527

ABSTRACT

La adenomatosis hepática es una enfermedad benigna definida por la aparición de múltiples adenomas en un hígado normal. Se trata de una entidad poco frecuente y de causa no conocida, de la que existen menos de un centenar de casos publicados en la literatura médica y que se ha relacionado con la toma de anticonceptivos orales o esteroides anabolizantes, con enfermedades por depósito y con mutaciones genéticas asociadas a la diabetes mellitus tipo MODY (maturity onset diabetes of the young). En los últimos años se ha comunicado la coexistencia de adenomatosis hepática con lesiones de esteatohepatitis no alcohólica en dos pacientes con síndrome metabólico, una asociación de interés por la creciente prevalencia de la enfermedad hepática grasa no alcohólica en los países desarrollados y por la posibilidad de que compartan un mecanismo causal. Comunicamos el caso de una mujer joven con fructosemia familiar y esteatosis hepática durante cuyo seguimiento aparecieron múltiples adenomas hepáticos asociados a lesiones de esteatohepatitis y discutimos el posible significado de dicha asociación (AU)


Hepatic adenomatosis is a benign disease defined as the presence of multiple adenomas in a normal liver. It is an uncommon condition and there are less than a hundred reported cases in the literature. The etiology is unknown, although it has been associated with the use of oral contraceptives, anabolic steroids, certain storage diseases and some genetic mutations linked to maturity onset diabetes of the young. The coexistence of hepatic adenomatosis and nonalcoholic steatohepatitis has been recently described in two patients suffering from metabolic syndrome. This association is particularly interesting due to the growing prevalence of nonalcoholic fatty liver disease in developed countries and the possibility of a common causal pathway. We report the case of a young woman with fructosemia and hepatic steatosis; multiple hepatic adenomas associated to steatohepatitis lesions were also found during clinical follow-up. The possible implications are discussed (AU)


Subject(s)
Humans , Female , Adult , Non-alcoholic Fatty Liver Disease/complications , Adenoma, Liver Cell/complications , Fructose/blood , Mutation/genetics , Genetic Predisposition to Disease , Hepatocyte Nuclear Factor 1-alpha/genetics
16.
Rev Esp Enferm Dig ; 110(3): 204-206, 2018 Mar.
Article in English | MEDLINE | ID: mdl-29277999

ABSTRACT

Hepatic adenomatosis is a benign disease defined as the presence of multiple adenomas in a normal liver. It is an uncommon condition and there are less than a hundred reported cases in the literature. The etiology is unknown, although it has been associated with the use of oral contraceptives, anabolic steroids, certain storage diseases and some genetic mutations linked to maturity onset diabetes of the young. The coexistence of hepatic adenomatosis and nonalcoholic steatohepatitis has been recently described in two patients suffering from metabolic syndrome. This association is particularly interesting due to the growing prevalence of nonalcoholic fatty liver disease in developed countries and the possibility of a common causal pathway. We report the case of a young woman with fructosemia and hepatic steatosis; multiple hepatic adenomas associated to steatohepatitis lesions were also found during clinical follow-up. The possible implications are discussed.


Subject(s)
Adenoma/complications , Liver Neoplasms/complications , Non-alcoholic Fatty Liver Disease/complications , Adenoma/diagnostic imaging , Adenoma/pathology , Adult , Female , Fructose Intolerance/etiology , Hepatocyte Nuclear Factor 1 , Humans , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/pathology , Magnetic Resonance Imaging , Non-alcoholic Fatty Liver Disease/diagnostic imaging , Non-alcoholic Fatty Liver Disease/pathology
17.
Rev. esp. enferm. dig ; 109(3): 230-233, mar. 2017. ilus
Article in English | IBECS | ID: ibc-160765

ABSTRACT

The endoscopic treatment of early gastrointestinal neoplasms usually involves the resection of the superficial layers, mucosa and submucosa, of the wall. However, in some circumstances, a fullthickness resection may be necessary. Endoscopic full-thickness resection (EFTR) may be an adequate approach in challenging lesions such as adenomas or early cancers with severe submucosal fibrosis or small sub-epithelial lesions in the lower GI tract. Furthermore, this novel technique has the potential to spare surgical therapy in a subset of cases. In this paper, we describe our results with the full-thickness resection device (FTRD) in three different situations (AU)


No disponible


Subject(s)
Humans , Male , Female , Adult , Aged , Colonic Neoplasms/surgery , Colonic Neoplasms , Endoscopy , Minimally Invasive Surgical Procedures/methods , Antibiotic Prophylaxis/instrumentation , Ceftriaxone/therapeutic use , Adenocarcinoma/surgery , Adenocarcinoma
18.
Rev Esp Enferm Dig ; 109(3): 230-233, 2017 Mar.
Article in English | MEDLINE | ID: mdl-28112966

ABSTRACT

The endoscopic treatment of early gastrointestinal neoplasms usually involves the resection of the superficial layers, mucosa and submucosa, of the wall. However, in some circumstances, a full-thickness resection may be necessary. Endoscopic full-thickness resection (EFTR) may be an adequate approach in challenging lesions such as adenomas or early cancers with severe submucosal fibrosis or small sub-epithelial lesions in the lower GI tract. Furthermore, this novel technique has the potential to spare surgical therapy in a subset of cases. In this paper, we describe our results with the full-thickness resection device (FTRD) in three different situations.


Subject(s)
Adenocarcinoma/surgery , Colon/surgery , Colonic Neoplasms/surgery , Endoscopy, Gastrointestinal/methods , Adult , Aged , Endoscopy, Gastrointestinal/instrumentation , Female , Humans , Male , Treatment Outcome
19.
Intern Med ; 55(18): 2595-9, 2016.
Article in English | MEDLINE | ID: mdl-27629952

ABSTRACT

Endometriosis is a quite common pathology, however, intestinal endometriosis is a rare condition, which typically occurs with chronic symptoms. Its acute presentation is very infrequent. We herein report four cases of intestinal endometriosis, in which the clinical debut occurred acutely: two as an acute small bowel obstruction and two as a small bowel perforation. None of the cases had a preoperative diagnosis of endometriosis. The interest of these cases lies in this exceptional form of presentation, such as a surgical acute abdomen. Therefore, intestinal endometriosis should be taken into account in the differential diagnosis of an acute obstructive or perforative process of the small or large bowel.


Subject(s)
Endometriosis/complications , Intestinal Obstruction/etiology , Intestinal Perforation/etiology , Abdomen, Acute/etiology , Acute Disease , Adult , Colectomy , Diagnosis, Differential , Endometriosis/surgery , Female , Humans , Intestinal Obstruction/diagnosis , Intestinal Obstruction/surgery , Intestinal Perforation/diagnosis , Intestinal Perforation/surgery , Intestine, Small/pathology , Middle Aged
20.
World J Gastrointest Oncol ; 6(9): 311-24, 2014 Sep 15.
Article in English | MEDLINE | ID: mdl-25232456

ABSTRACT

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a noninvasive epithelial neoplasm of mucin-producing cells arising in the main duct (MD) and/or branch ducts (BD) of the pancreas. Involved ducts are dilated and filled with neoplastic papillae and mucus in variable intensity. IPMN lacks ovarian-type stroma, unlike mucinous cystic neoplasm, and is defined as a grossly visible entity (≥ 5 mm), unlike pancreatic intraepithelial neoplasm. With the use of high-resolution imaging techniques, very small IPMNs are increasingly being identified. Most IPMNs are solitary and located in the pancreatic head, although 20%-40% are multifocal. Macroscopic classification in MD type, BD type and mixed or combined type reflects biological differences with important prognostic and preoperative clinical management implications. Based on cytoarchitectural atypia, IPMN is classified into low-grade, intermediate-grade and high-grade dysplasia. Based on histological features and mucin (MUC) immunophenotype, IPMNs are classified into gastric, intestinal, pancreatobiliary and oncocytic types. These different phenotypes can be observed together, with the IPMN classified according to the predominant type. Two pathways have been suggested: gastric phenotype corresponds to less aggressive uncommitted cells (MUC1 -, MUC2 -, MUC5AC +, MUC6 +) with the capacity to evolve to intestinal phenotype (intestinal pathway) (MUC1 -, MUC2 +, MUC5AC +, MUC6 - or weak +) or pancreatobiliary /oncocytic phenotypes (pyloropancreatic pathway) (MUC1 +, MUC 2-, MUC5AC +, MUC 6 +) becoming more aggressive. Prognosis of IPMN is excellent but critically worsens when invasive carcinoma arises (about 40% of IPMNs), except in some cases of minimal invasion. The clinical challenge is to establish which IPMNs should be removed because of their higher risk of developing invasive cancer. Once resected, they must be extensively sampled or, much better, submitted in its entirety for microscopic study to completely rule out associated invasive carcinoma.

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