Diagnostic yield of computed tomography guided fine-needle aspiration for pancreatic cancer.

Fine-needle aspiration (FNA) for the histological diagnosis of occupying lesions in the pancreas as opposed to tru-cut needle biopsy to obtain tissue for analysis has been associated with a lower incidence of post-procedure complications, with almost immediate recovery and no need for hospital stay. Nevertheless, the question of the diagnostic effectiveness of percutaneous computed axial tomography (CT)-guided FNA in solid pancreatic lesions has been raised. The aim of this study was to confirm the diagnostic effectivity of percutaneous CT-guided FNA in pancreatic space-occupying lesions and to assess short-term complications. All percutaneous CT-guided FNA with real-time monitoring, performed between April 2010 and December 2015, were retrospectively analyzed. In all cases 21-gauge needles were used. All FNA were performed in the presence of a pathologist who immediately stained and reported as adequate for analysis in all cases. The diagnosis was confirmed by histopathological evaluation. Of 54 FNA performed, final histopathological evaluation revealed neoplastic cells compatible with adenocarcinoma in 52 patients (96%) and was negative for neoplastic cells in two patients (4%). The sensitivity was 94%, and the specificity 100%. Post-FNA morbidity was observed in four patients, consisting of epigastric pain in two and abdominal wall hematoma in two other patients. Percutaneous CT-guided FNA of pancreatic space-occupying lesions was found to be a good, minimally invasive and safe method with low morbidity. The presence of the pathologist in the procedure allowed for immediate cytological diagnosis.

El uso de la punción-aspiración con aguja fina (PAAF) en el diagnóstico histológico de lesiones ocupantes de páncreas es una alternativa frente al uso de agujas tru-cut en la obtención de tejido para su análisis, con una incidencia más baja de complicaciones y una recuperación casi inmediata sin necesidad de internación. El objetivo fue valorar la efectividad diagnóstica de las PAAF de lesiones ocupantes pancreáticas guiadas por tomografía axial computada (TAC) por vía percutánea, y su tasa de complicaciones a corto plazo. Se analizaron de forma retrospectiva todas las PAAF realizadas mediante guía tomográfica por vía percutánea con control en tiempo real, entre abril 2010 y diciembre 2015. Todas las PAAF se realizaron en presencia de un patólogo que inmediatamente tiñó e informó como adecuado para el análisis. La confirmación diagnóstica se hizo con el análisis anatomopatológico diferido. De las 54 PAAF realizadas, el diagnóstico anatomopatológico informó positivo para células neoplásicas compatible con adenocarcinoma en 52 pacientes (96%) y en otros dos (4%) como negativo para células neoplásicas. La sensibilidad del método fue 94% y la especificidad del 100%. Se registraron 4 casos de morbilidad post punción (2 dolores epigástricos y 2 hematomas de pared abdominal). Las punciones percutáneas de lesiones ocupantes pancreáticas guiadas por TC pueden considerarse un buen método diagnóstico mini invasivo, seguro, con una morbilidad post punción baja. La presencia del patólogo en el procedimiento permitió el diagnóstico citológico inmediato.

Diagnostic yield of computed tomography guided fine-needle aspiration for pancreatic cancer / Rendimiento diagnóstico de la aspiración con aguja fina guiada por tomografía computarizada para el cáncer de páncreas

Abstract Fine-needle aspiration (FNA) for the histological diagnosis of occupying lesions in the pancreas as opposed to tru-cut needle biopsy to obtain tissue for analysis has been associated with a lower incidence of post-procedure complications, with almost immediate recovery and no need for hospital stay. Nev ertheless, the question of the diagnostic effectiveness of percutaneous computed axial tomography (CT)-guided FNA in solid pancreatic lesions has been raised. The aim of this study was to confirm the diagnostic effectivity of percutaneous CT-guided FNA in pancreatic space-occupying lesions and to assess short-term complications. All percutaneous CT-guided FNA with real-time monitoring, performed between April 2010 and December 2015, were retrospectively analyzed. In all cases 21-gauge needles were used. All FNA were performed in the pres ence of a pathologist who immediately stained and reported as adequate for analysis in all cases. The diagnosis was confirmed by histopathological evaluation. Of 54 FNA performed, final histopathological evaluation revealed neoplastic cells compatible with adenocarcinoma in 52 patients (96%) and was negative for neoplastic cells in two patients (4%). The sensitivity was 94%, and the specificity 100%. Post-FNA morbidity was observed in four patients, consisting of epigastric pain in two and abdominal wall hematoma in two other patients. Percutaneous CT-guided FNA of pancreatic space-occupying lesions was found to be a good, minimally invasive and safe method with low morbidity. The presence of the pathologist in the procedure allowed for immediate cytological diagnosis.

Resumen El uso de la punción-aspiración con aguja fina (PAAF) en el diagnóstico histológico de lesiones ocupantes de páncreas es una alternativa frente al uso de agujas tru-cut en la obtención de tejido para su análisis, con una incidencia más baja de complicaciones y una recuperación casi inmediata sin necesidad de internación. El objetivo fue valorar la efectividad diagnóstica de las PAAF de lesiones ocupantes pancreáticas guiadas por tomografía axial computada (TAC) por vía percutánea, y su tasa de complicaciones a corto plazo. Se analizaron de forma retrospectiva todas las PAAF realizadas mediante guía tomográfica por vía percutánea con control en tiempo real, entre abril 2010 y diciembre 2015. Todas las PAAF se realizaron en presencia de un patólogo que inmediatamente tiñó e informó como adecuado para el análisis. La confirmación diagnóstica se hizo con el análisis anatomopatológico diferido. De las 54 PAAF realizadas, el diagnóstico anatomopatológico informó positivo para células neoplásicas compatible con adenocarcinoma en 52 pacientes (96%) y en otros dos (4%) como negativo para células neoplásicas. La sensibilidad del método fue 94% y la especificidad del 100%. Se registraron 4 casos de morbilidad post punción (2 dolores epigástricos y 2 hematomas de pared abdominal). Las punciones percutáneas de lesiones ocupantes pancreáticas guiadas por TC pueden considerarse un buen método diagnóstico mini invasivo, seguro, con una morbilidad post punción baja. La presencia del patólogo en el procedimiento permitió el diagnóstico citológico inmediato.

Impact of the COVID-19 pandemic and restrictive measures on acute appendicitis: Do not let your guard down.

Background: The COVID-19 pandemic has altered the usual dynamics of consultation and presentation for acute appendicitis (AA). The aim of this study was to evaluate the impact of the pandemic and restrictive measures on the cases of AA. Subjects and Methods: A retrospective study of patients diagnosed with AA between December 2019 and July 2020 was conducted. Patients were classified into two groups; one that underwent treatment in the 16 weeks before the implementation of lockdown in Argentina (Group 1) and another that underwent treatment in the 16 weeks after (Group 2). Demographic, clinical and surgical variables were evaluated. Results: Overall, 91 patients underwent surgery, 61 and 30 patients in each group, showing a 51% drop in the incidence. The second group delayed seeking medical care longer (mean 46 h vs. 27 h, P < 0.05), had a higher rate of perforated appendicitis (30% vs. 11%, P < 0.05) and a higher rate of complicated appendicitis (56.6% vs. 18%, P < 0.01). These results were associated with a longer operative time (43.7 ± 15.5 min vs. 36.1 ± 11.1 min, P < 0.05) and a longer mean length of hospital stay (1.9 days vs. 1.4 days, P < 0.01); however, no increase in the quantity and severity of post-operative complications was observed. Conclusion: COVID-19 pandemic and restrictive social measures led to fewer consultations for abdominal pain, resulting in a lower number of AA diagnosed. In addition, a longer delay in seeking medical care was observed, leading to more advanced disease, longer operative time and length of hospital stay.

Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas diagnosed by endoscopic ultrasound guided biopsy.

Undifferentiated pancreatic carcinoma with osteoclast-like giant cells is a rare tumour that has been published under a wide variety of names, including pleomorphic carcinoma, giant cell carcinoma, sarcomatoid carcinoma and carcinosarcoma, among others. For these reasons and its low frequency, the reports of these tumours are scarce and frequently lead to confusion with other entities which present with giant cells. We present the case of a patient with obstructive jaundice and a mixed cystic and solid pancreatic mass, accompanied by multiple hepatic lesions. The histological study of the material obtained by endoscopic ultrasound guided biopsy demonstrated a proliferation of atypical epithelioid cells, accompanied by a spindle cell component with marked pleomorphism and numerous osteoclast-like giant cells. The epithelioid component showed positive immunostaining with cytokeratin cocktail and cytokeratin 7. The spindle cell component showed coexpression of cytokeratins and vimentin. The osteoclast-like giant cells were positive for CD68. Protein p53 was overexpressed in both epithelial and spindle cell neoplastic components, and was negative in the giant cells. These findings permitted the diagnosis of undifferentiated carcinoma of the pancreas with osteoclast-like giant cells. This case outlines the effectiveness of endoscopic ultrasound-guided biopsy and the importance of morphological and immunohistochemical examination in the diagnosis of different types of pancreatic tumours, especially when they are in advanced stages and are not suitable for surgical treatment.

Isolated gallbladder metastasis of melanoma: Case report.

BACKGROUND: Although metastatic melanoma is most frequently found in liver, lungs, and brain, most metastases found in the gallbladder are from melanoma. Here, we present a case of isolated metastatic melanoma found during cholecystectomy. PRESENTATION OF CASE: 74-year-old male with a personal history of hypertension, diabetes mellitus, obesity, and arrhythmia. A skin lesion was found on the right malar region. An excisional biopsy was performed and histopathological examination showed an ulcerated nodular-type malignant melanoma, Breslow 7.6 mm, Clark IV. Surgical excision with margins of 2 cm and sentinel lymph-node biopsy was carried and were negative. Abdominal sonography at 6 months showed an 18 mm solid mass adhered to the wall of the gallbladder that was suggestive of a polyp. Thorax-abdomen-pelvis CT showed no abnormalities. The gallbladder lesion had increased in volume on the following sonography and therefore, cholecystectomy was performed. Histopathological study revealed melanoma infiltrating the mucosa and muscular layer. Written informed consent was previously obtained, and Institutional Review Board approval was not needed. DISCUSSION: Isolated metastatic melanoma in the gallbladder is uncommon. Follow-up controls with images are important in the diagnosis. As most metastatic melanoma to the gallbladder are asymptomatic, surgeons should have high level of suspicion. Cholecystectomy could prolong survival in these patients. CONCLUSION: Isolated gallbladder metastasis of melanoma is an uncommon presentation of this disease. Laparoscopic cholecystectomy is an adequate procedure in this particular situation and may improve patient survival. The presentation of this case may help surgeons to maintain a high level of suspicion regarding the condition.

Abordaje laparoscópico simultáneo del cáncer de colon con metástasis hepáticas / Simultaneous laparoscopic approach for colon cancer and liver metastases

Antecedentes: la hemicolectomía derecha laparoscópica con abordaje suprapúbico (HDLS) y empleo de tecnología. En los pacientes con cáncer de colon con metástasis hepáticas sincrónicas (CCMHS), la resección completa del tumor primario con las metástasis es la única opción de tratamiento con intención curativa. Se conocen varios informes de series de casos en el mundo; sin embargo, no existe ningún estudio aleatorizado controlado. Objetivo: el objetivo es evaluar la factibilidad y seguridad del abordaje laparoscópico simultáneo de la resección del tumor primario de colon y de la metástasis hepática. Material y métodos: es un estudio retrospectivo; a tal fin se recolectaron todos los pacientes con sospecha de CCMHS abordados por laparoscopia con intención de resección simultánea del tumor primario de colon con las metástasis hepáticas. Se analizaron variables preoperatorias, operatorias, resultados a corto y largo plazo, y anatomopatológicas. Resultados: en el período de estudio se realizaron 89 resecciones hepáticas laparoscópicas (RHL). En 28 pacientes se realizó ‒en forma simultánea con la RHL‒ otro procedimiento, en 21 de los cuales fue una colectomía laparoscópica. El tiempo quirúrgico promedio total de los dos procedimientos llegó a 407 minutos. El promedio de días de estadía hospitalaria fue de 8 días. No hubo mortalidad en la serie, y la morbilidad global fue del 71%, pero un solo caso con morbilidad mayor. La sobrevida global y la sobrevida libre de recurrencia a los 3 años fue de 55,2% y 16,3%, respectivamente. Conclusión: Esta es la primera publicación acerca del tema en nuestro país. Podemos decir que, en casos bien seleccionados, el abordaje laparoscópico simultáneo es factible de realizar, con aceptable morbimortalidad y sin comprometer los resultados oncológicos.

Background: In patients with colorectal cancer with synchronous liver metastases (CLM), complete resection of the primary tumor with the metastases is the only option for curative treatment. Several case series have been reported but no randomized controlled trials have been published. Objective: The aim was to evaluate if the simultaneous laparoscopic resection of the primary colon tumor and liver metastases is feasible and safe. Material and methods: A retrospective study was conducted with patients with suspected CLM scheduled for simultaneous laparoscopic resection of the primary tumor of the colon and liver metastases. The preoperative and operative variables, short- and long-term outcomes and pathological variables were analyzed. Results: A total of 89 laparoscopic liver resections (LLR) were performed during the study period. In 28 patients, LLR was simultaneous with other procedures, 21 of which corresponded to laparoscopic colon resection. Mean surgical time for both procedures was 407 minutes. Mean hospital length of stay was 8 days. None of the patients died and overall morbidity rate was 71% with only one major complication. Overall survival and relapse-free survival at three years was 55.2% and 16.3%, respectively. Conclusion: This is the first publication analyzing this approach in our country. In well selected cases, the simultaneous laparoscopic approach is feasible, with low morbidity and mortality and acceptable oncological results.

Laparoscopic liver resection in metastatic colorectal cancer treatment: comparison with long-term results using the conventional approach.

BACKGROUND: Laparoscopic liver resections (LLRs) have been shown to be both feasible and safe. However, no randomised control studies have been performed to date comparing results with those of the open surgery approach. MAIN AIM: To analyse LLR long-term results and compare them with a similar group of open resections in patients with colorectal carcinoma liver metastasis (CRCLM). METHODS: Retrospective study on a prospective database. All patients with anatomopathological diagnosis of CRCLM resected between July 2007 and July 2015. RESULTS: Twenty-two open resections and 18 laparoscopic resections which presented favourable lesions for laparoscopic approach were analysed. Postoperative grade III morbidity was similar in both groups (p = 0.323). Disease-free survival at 1, 3, and 8 years in the laparoscopy group (n =16) was 81%, 58%, and 58%, respectively, while in the open surgery group (n = 17) it was 64%, 37%, and 19% respectively; no differences were found (p = 0.388). Global survival in the laparoscopy group was 93%, 60%, and 40%, respectively, and 88%, 74.5%, and 58.7%, respectively, in the open surgery group; no differences were found (p = 0.893) with a 37 months average follow-up. CONCLUSION: LLR in patients with technically favourable CRCLM had similar morbidity to open resections and resection margins were not compromised because of laparoscopy.

Laparoscopic resection for liver tumors: initial experience in a single center.

BACKGROUND: Laparoscopic liver resections are 1 of the most complex procedures in hepatobiliary surgery. During the last 20 years, laparoscopic liver surgery has had an important development in specialized centers. OBJECTIVE: To describe the initial experience in laparoscopic liver resection for benign and malignant tumors, to assess its indications and outcomes, and to describe technical aspects of these resections. METHODS: Review of the records of 28 patients who underwent laparoscopic liver resection between November 2000 and November 2007. Analysis of the data regarding preoperative management and postoperative outcomes. RESULTS: Twenty-six liver resections were performed laparoscopically (20 purely laparoscopic, 3 hand assisted, and 3 hybrid technique) and 2 were converted to open surgery. The laparoscopic approach was attempted in 6% (28 out of 459) of the liver resections carried out in the analyzed period. Indications for resection were: benign tumors in 22 patients (78%) and malignant tumors in 6 patients (22%). Resections were minor in 27 patients (96%) and major in 1 patient (4%). Pringle maneuver was performed in 14 patients (50%). Margins were negative in all the cases. Mean operative time was 170 minutes (range 70 to 350), and the mean length of stay was 3 days (range 1 to 6). Mortality rate was 0%. Only 2 patients (7%) had postoperative minor complications (self-limited bile leaks). CONCLUSIONS: In selected patients with benign and malignant liver tumors, laparoscopic liver resections can be safely performed. This procedure must be carried out by the surgeons trained in both the hepatobiliary and laparoscopic surgery.

La colangiografía intraoperatoria selectiva en colecistitis aguda / The selective intraoperating colangiografía in acute colecistitis

Antecedentes: Está generalmente aceptado que la colecistitis aguda (CA) se asocia a un aumento de la incidencia de litiasis coledocina (LC) y de lesión quirúrgica de la vía biliar (LQVB), haciendo más necesaria la colangiografía intraoperatoria (CIO). No obstante, no existe suficiente información sobre la posibilidad de un eventual aumento de litiasis residual insospechada o LQVB asociados a la CIO selectiva en CA en servicios con experiencia en esta cirugía. Objetivo: Analizar la posibilidad de emplear la CIO selectiva en colecistectomías laparoscópica de pacientes con CA sin aumentar la morbilidad. Lugar de aplicación: Hospital Privado de Comunidad. Diseño: Análsis retrospectivo con datos registrados en forma prospectiva. Población: 345 pacientes consecutivos con coleccistectomías laparoscópicas por CA con CIO selectiva (pacientes sin evidencia clínica, de laboratorio o ecográfica de colestasis). período: junio/1993 - junio/2003. Método: Registro de incidencia de LC y LQVB en la serie. Registro de las conversaciones a cirugía abierta y de las CIO realizadas, y su indicación. Resultados: Ningún paciente tuvo litiasis biliar comparada ni LQVB, con un seguimiento del 92% de los mismos durante 23 meses promedio (rango: 19 a 30 meses). Se conviertieron a cirugía abierta por dificultades operatorias 5 operados (1,5%). Se realizó CIO en 46 casos por las dudas anatómicas (13,3%), que no evidenciaron LC. Conclusiones: la ausencia de CIO en 345 colecistectomías laparoscópicas consecutivas de pacientes con CA sin alteraciones del hepatograma ni dilatación ecográfica de la vía biliar no tuvo morbilidad, en términos de LQVB y litiasis coledociana insospechada, luego de un seguimiento de 23 meses promedio. La utilidad de la CIO se evidenció en las dudas anatómicas durante la intervención. Estos datos plantean la posibilidad de aplicar también la CIO selectiva en colecistectomías laparoscópicas de pacientes con colecistitis aguda en equipos quirúrgicos con experiencia...