Hepatocarcinoma simulando hiperplasia nodular focal / No disponible

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Liver transplantation in patients with hepatocellular carcinoma: factors implicated in tumor relapse.

INTRODUCTION: Liver segmental resection and liver transplantation are both treatments intended for healing liver cancer. An adequate selection of patients eligible for transplantation is crucial, since organs available for transplants are usually scarce. For this reason, awareness of the prognostic factors of relapse is of great importance. We present a comprehensive review of our series in order to better understand these prognostic factors. MATERIAL AND METHODS: We revised the cases of patients with hepatocellular carcinoma who underwent liver transplantation during the period 1994-2000, and present a detailed analysis of a series of variables which may be probably implicated in the appearance of relapse and which have an effect on survival. RESULTS: After a mean follow-up of 33 months, the mortality rate was 27.5% and relapse occurred in 18.75% of cases. No history of alcohol abuse, the number and size of the nodules, the presence of macro and microscopic vascular invasion, and pTNM stage T4 were all factors associated with a significantly increased risk of relapse (p<0.05). These factors and positive HCV were associated to decreased survival. After a multivariate analysis, the size of the nodules and the presence of macroscopic vascular invasion were considered the only independent risk factors for tumor relapse and post-transplantation relapse and mortality, respectively. CONCLUSIONS: Macroscopic vascular invasion and tumor nodules larger than 5 cm are both independent risk factors of tumor relapse after transplantation. Nevertheless, only macroscopic vascular invasion seems to have a significant effect on survival.

Experimental study using PTFE (Goretex) patches for replacement of the oesophageal wall.

BACKGROUND: The purpose of this study was to evaluate tolerance and integration of expanded polytetrafluoroethylene patches used to replace loss of a fragment of the complete oesophageal wall in rats of the Wistar strain. METHODS: The experiment was performed on 10 Wistar rats. Those surviving the experiment were killed 7-28 days after surgery. RESULTS: None of these animals showed signs of peritonitis. The patch was not visible macroscopically. After examination under the microscope, we observed that the material had undergone phagocytosis by macrophages, and there was scar tissue covering the epithelium. CONCLUSION: It is possible to successfully suture a polytetrafluoroethylene patch to the oesophageal wall in Wistar rats as a prosthetic replacement of a wall fragment.

Linfomas gástricos MALT en estadio precoz: erradicación de H.Pylori y evolución / Early-stage gastric MALT lymphomas: eradication of H.Pylori and out come

Antecedentes y objetivo: se ha visto que los linfomas gástricos de bajo grado de malignidad desarrollados en el tejido linfoide asociado a mucosas (MALT) y diagnosticados en un estadio precoz desaparecen tras la erradicación de Helicobacter pylori (HP) en un alto porcentaje, variable según distintos estudios. De hecho muchos autores consideran éste el tratamiento de elección en estos casos. El objetivo de este estudio es describir retrospectivamente la respuesta al tratamiento erradicador y su evolución en pacientes con estos linfomas desde la introducción de las exploraciones ecoendoscópicas en el Servicio de Enfermedades Digestivas del Hospital Juan Canalejo de La Coruña. Materiales y métodos: hemos realizado una revisión retrospectiva de los casos observados en nuestro centro, desde junio 1997 a diciembre 2001 de linfomas gástricos MALT de bajo grado en estadio EI1, diagnosticados por biopsia y estadificados con ecoendoscopia. El HP fue erradicado en estos pacientes con triple terapia. Se les realizó controles endoscópicos con biopsias a los dos, tres, seis meses y después anualmente. Resultados: en este periodo 14 pacientes fueron diagnosticados de linfoma gástrico del MALT en los que la exploración ecoendoscópica demostró afectación sólo hasta la submucosa (estadio EI1). La edad mediana fue 65 años y 57 por ciento fueron mujeres. La erradicación de HP se consiguió en todos los pacientes con uno o dos ciclos (en 2 pacientes) de tratamiento. Con este tratamiento se obtuvo una remisión completa del linfoma en 10 pacientes (71,4 por ciento),en una mediana de tiempo de 4,5 meses. El resto precisó quimioterapia por falta de respuesta, por recidiva o como terapéutica inicial (un caso); en todos ellos consiguiendo también una remisióncompleta. Se realizó seguimiento en 9 pacientes, una mediana de tiempo de 20 meses, tras el cual todos permanecen sin evidencia de enfermedad. Conclusiones: los linfomas B MALT de bajo grado en estadioprecoz (EI1) tienen una tasa de respuesta alta al tratamiento erradicador de HP. La estadificación por ecoendoscopia nos permite distinguir este grupo de pacientes que se beneficiarán de un tratamiento más conservador. Aún así es preciso un seguimiento pues queda por establecer si esta remisión se mantiene a largo plazo, así como estudiar los factores que se asocian a recidivas (AU)

Early-stage gastric MALT lymphomas: eradication of H. pylori and outcome.

BACKGROUNDS AND OBJECTIVE: Lymphomas of mucosa-associated lymphoid tissue are special because of their indolent course. Low-grade early-stage tumors resolve after Helicobacter pylori (HP) eradication in a high percentage of cases. The aim of this study was to evaluate this regression in our patients with EI1 stage-low-grade B gastric lymphomas after eradication therapy since the introduction of echoendoscopic examinations in the Gastroenterology Department of 'Juan Canalejo' Hospital. MATERIAL AND METHODS: A retrospective study of all cases of low-grade MALT gastric lymphomas in EI1 stage, diagnosed by histological and echoendoscopic examination, from June 1997 to December 2001. After eradication of HP with triple therapy, patients have been followed-up with endoscopic examinations at 2, 3 and 6 months, and yearly afterwards. RESULTS: There were 14 patients in this period with low-grade EI1 stage gastric MALT B cell lymphoma. The median age was 65 years, and 57% were females. HP was eradicated in all cases with first- or second-line (2 patients) antibiotic treatment. Complete remission was observed in 10 patients (71.4%) in a median time of 4.5 months. The other 4 patients needed chemotherapy because of non-remission or early relapse, and also as initial treatment. Complete remission was also obtained in these patients. Only 9 patients have been followed up in our unit for a median time of 20 months, period after which all remain free of disease. CONCLUSIONS: Low-grade early-stage MALT gastric B-cell lymphomas have a high rate of response to HP eradication therapy. Echoendoscopic staging helps in distinguishing the group of patients who will benefit from conservative treatment. These patients must be followed up as it remains unclear whether remission is maintained in the long term, and to know what factors could be associated with lymphoma relapse.

Diferencias entre carcinomas infrecuentes y adenocarcinomas habituales de la vesícula biliar / Differences between uncommon carcinomas and usual gallbladder adenocarcinomas

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[Mucinous adenocarcinoma of the urachus synchronic with colorectal adenocarcinoma. Value of immunohistochemistry in the differential diagnosis]. / Adenocarcinoma mucinoso de uraco sincrónico con adenocarcinoma colorrectal. Valor de la inmunohistoquímica en el diagnóstico diferencial.

The coincidence of an urachal adenocarcinoma with another similar tumour in other location makes necessary to separate a true primary from a metastatic adenocarcinoma. We report the case of a 66-years-old-man with an urachal mucinous adenocarcinoma and two colonic adenocarcinoma excised in the same surgical act, showing both macro and microscopic studies together with immunohistochemical techniques, that were useful to differentiate the origin of both neoplasms. Among them, the antibody to keratin 7, a cytoplasmic epithelial protein, was positive in the urachal and negative in the colonic tumour.

[Perforated jejunal tuberculosis in a patient with HIV-infection]. / Tuberculosis yeyunal perforada en paciente con infección por VIH.

Patients with AIDS are particularly susceptible to tuberculosis infection with a high incidence of extrapulmonary disease and surgical complications. Authors describe a 38-year-old male infected with the human immunodeficiency virus who presented intestinal perforation due to mycobacterium tuberculosis. A resection of jejunum was performed with primary anastomosis. The postoperative course was further compromised by hepatic failure and the patient died 16 days after the initial surgery.

[Heterotopic gastric mucosa in the ileum with perforated ulcer]. / Mucosa gástrica heterotópica de íleon con úlcera perforada.

Heterotopic gastric mucosa (HGM) in the small bowel, other than in the Meckel's diverticulum or other congenitally anomalous bowel, is exceedingly rare. A patient with HGM of the small intestine with perforation of the ileum due to ulceration of the adjacent mucosa is presented. The authors remark the importance of the histological criteria to differentiate between true HGM from metaplastic changes, two entities with different behavior and prognostic implications.

[Undifferentiated small cell carcinoma (oat-cell type) of the colon. Prognostic and therapeutic implications]. / Carcinomas indiferenciados de células pequeñas (Tipo oat-cell) de colon. Implicaciones pronósticas y terapéuticas.

AIM: This report reviews the clinical and pathologic features of four patients with small-cell anaplastic carcinoma (SCAC) of the colon and describes in detail their histological and immunohistochemical characteristics. METHODS: Four patients with a SCAC of the colon diagnosed by conventional light microscopy, immunohistochemistry and ultrastructure were reviewed; clinical presentation, tumor location and spread, surgical procedure, adjuvant therapy and clinical outcome were recorded. RESULTS: There were two women and two man, with an average age of 55 (range, 40-66) years. Two tumors were located in the sigmoid and two in right colon. Cases 1, 3 and 4 were removed at laparotomy by segmental resection along with lymph nodes. All cases had liver metastases. Pathologic study identified out-cell subtype in all cases and two histopathologic patterns: pure SCAC (cases 2 and 4) and mixed exocrine-SCC differentiation (cases 1 and 3). Three patients were treated with cyclophosphamide, cisplatin and etoposide. Two patients (cases 2 and 4) died of widely metastatic disease; cases 1 and 3 had partial remission lasting 9 and 3 months, respectively. CONCLUSIONS: Due to extremely aggressive behavior of colon SCAC with early metastatic spread, CT scans of the chest-abdomen and radionuclide bone scan should be performed. In the presence of metastatic disease, multiagent chemotherapy with combined etoposide and cisplatin should be instituted.

Giant primary amyloidoma of the tonsil.

A case of giant amyloidoma in the left tonsil with extensive osseous metaplasia and a scanty and patchy monoclonal population of IgG Kappa plasma cells, is presented. Localized tumoral amyloidosis is a rare, benign tumour of the upper aerodigestive tract. Organ-limited amyloidosis has been shown to be confined to various systems but, since the lesion was first described, only four cases situated in the tonsils have been reported in the English literature, and none of these had either osseous metaplasia or a monoclonal population of IgG Kappa plasma cells.

[Cardiac osteogenic sarcoma with chondroblastic differentiation]. / Sarcoma osteogénico cardiaco con diferenciación condroblástica.

Cardiac tumors are a rare disease. We show here one patient with a heart osteogenic sarcoma with chondroblastic differentiation. The clinical status was initiated with a cadre of cardiac tamponade. Transesophageal echocardiography and thoracic scanner were used to diagnose the cardiac tumor. The definitive diagnosis was confirmed with biopsy. At the present moment, there are very few cases reported in the references on osteogenic sarcoma with chondroblastic differentiation. The methods of diagnosis, the treatment and the histopathology are discussed.

[Lip biopsy of minor salivary glands in Sjogren's syndrome: histological findings and clinico-pathological correlations]. / Biopsia labial de glándulas salivares menores en el síndrome de Sjögren: hallazgos histológicos y correlaciones clínico-patológicas.

Thirty-seven lip biopsies of minor salivary glands from patients with suspected Sjögren syndrome (SS) and no other known disease were studied. Two cases were excluded for not meeting disease criteria (one had histologic findings of sarcoidosis). Of 35 SS cases, 4 were considered secondary to associated disease. In 24 cases the Daniels technique was used and in 11, an elliptical excision. In 3 elliptical excisions (27.3%) the biopsy did not contain glands (p = 0.002 compared with the Daniels technique). The mean number of glands per biopsy was 7.7 (2-16) with the Daniels technique and 5 (0-15) by elliptical excision (no significant difference). Focal lymphoid sialoadenitis was present in all 32 gland-bearing specimens. Multiple inflammatory foci were found in 28 (87.5%), 8(25%) of which had a diffuse infiltrate. SS presented more frequently as xerostomy in patients with diffuse infiltrate (p = 0.09). In 11 lip biopsies from controls with other diseases of the oral cavity, 7 (63.6%) showed changes suggestive of SS.