Metástasis óseas, primera manifestación clínica de un carcinoma productor de calcitonina / Bone metastases as the first clinical manifestation of a thyroid medullar carcinoma

Introducción: el carcinoma medular de tiroides comprende entre el 5%-10% de todos los carcinomastiroideos. La presentación clínica más frecuente es una masa tiroidea. Caso clínico: varón de 32 años, con dolores debidos a múltiples metástasis óseas. Una biopsia de médulaósea mostró un carcinoma con positividad inmunohistoquímica a calcitonina y antígeno carcinoembrionario.Los niveles séricos de calcitonina y antígeno carcinoembrionario estaban muy altos. El paciente murió a los 12 meses del diagnóstico a pesar de ser sometido a quimio y radioterapia. Discusión: las metástasis a distancia son una manifestación inicial infrecuente en el carcinoma medularde tiroides. Pacientes con menos de 45 años tienen mejor supervivencia, pero la existencia de metástasis óseasse correlaciona con mal pronóstico. Las determinaciones inmunohistoquímicas y séricas de calcitonina y antígenocarcinoembrionario son importantes instrumentos diagnósticos. Conclusión: mostramos lo que creemos es un carcinoma medular de tiroides en un varón joven, con una presentación inicial atípica debido a múltiples metástasis óseas y curso fatal. La inmunohistoquimia es fundamentalpara diagnosticar el tumor primario en estas metástasis. En el caso de calcitonina y/o antígeno carcinoembrionarioplasmático elevado y no explicado, es imprescindible descartar un carcinoma medular de tiroides

Purpose: Thyroid medullary carcinoma comprises between 5 and 10 % of all thyroid cancers. The mostcommon clinical presentation is a thyroid mass. Study of a case with bone metastases. Case report: A 32 year old man with pain due to multiple bone metastases. A bone marrow biopsydisclosed a carcinoma immunologically positive to calcitonin and carcinoembryonic antigen. Serum level ofboth, calcitonin and carcinoembryonic antigen, were very high. The patient was treated with chemotherapy andradiotherapy, and died 12 months later. Discussion: Distant metastases are not a usual presentation of thyroid medullary carcinoma. Patientsyounger than 45 years have a better survival, but bone metastases correlate with a very bad prognosis.Immunohistochemistry and blood determination of carcinoembryonic antigen and calcitonin are importantdiagnostic tools. Conclusion: Atypical presentation of a thyroid medullary carcinoma in a young man with bonemetastases and short survival. Immunohistochemistry is very useful to establish the origin of the primarytumour in these metastases. In the event of an unexplained plasma rise of calcitonin and/or carcinoembryonicantigen, it is mandatory to rule out a thyroid medullary carcinoma

[Leiomyosarcoma and rhabdomyosarcoma: rare tumors of the kidney]. / Leiomiosarcoma y rabdomiosarcoma: tumores raros del riñón.

Renal sarcoma represents 2.8% of all renal malignant tumours. The most common kind is leiomyosarcoma while rhabdomyosarcoma is the most unusual. Clinical presentation and diagnosis of both types of tumours are unspecific. Treatment is controversial and the overall prognosis poor. The present paper presents two cases, one leiomyosarcoma and one rhabdomyosarcoma which were treated surgically and were followed by chemo- and radiotherapy. A revision of the criteria for grading these as primary tumours of the kidney is also included.

[Endometriosis: an infrequent cause of colonic obstruction]. / Endometriosis: una causa infrecuente de obstrucción colónica.

Endometriosis localized in the intestinal wall is not an infrequent finding. Diagnosis is difficult given the diverse symptomatology presented with unspecific abdominal pain being the most common. Implantation of endometrial tissue in the intestinal wall may involve the mucosa and present as rectorhagia, with colonscopic exploration providing diagnosis by biopsy of the affected area. In other cases this may only involve the intestinal wall producing very varied symptomatology. Presentation as a picture of colon obstruction is little reported. The main problem is its difficult differential diagnosis with neoplasm which, in most cases, leads to surgery. A case of colon obstruction provoked by implantation of endometrial tissue in the wall of the sigma which was surgically resolved is herein presented.