Lymphogranuloma venereum: an unusual cause of rectal stenosis.

Lymphogranuloma Venereum (LGV) is a notifiable disease linked to high-risk sexual practices such as cruising, chemsex, or orgies. The anorectal manifestation is associated with receptive anal sex and presents with characteristic symptoms such as proctitis, tenesmus, suppuration, and in advanced cases, anorectal fistulas or stenosis. The case of a 57-year-old man engaging in high-risk sexual practices is presented, showing symptoms such as discharge, fistulizations, rectal stenosis, and a weight loss of 15 kg. Following diagnostic studies, a neoplastic and inflammatory origin was ruled out, confirming the LGV diagnosis. Although the patient responded positively to a three-week course of doxycycline, the stenosis persisted, ultimately necessitating a terminal colostomy. The patient was scheduled to undergo a protectomy to control the inflammatory and infectious process, a procedure that took place months later without significant incidents. The primary treatment for LGV continues to be doxycycline. In cases of complications, such as fistulas, abscesses, or stenosis, surgical interventions, drainage, or pneumatic dilations may be necessary.

Prostate gland metastasis as a late relapse of rectal adenocarcinoma.

We present a case report of a 49 year old patient with a known history of rectal adenocarcinoma treated with extended abdominal perineal resection. After five the patient was diagnosed with metastases to the prostate gland. This case stands out not only due to the infrequency of an onset of a colorectal tumor in the prostatic gland but also the late onset of the tumor. In these cases the differential diagnosis between a metastatic tumor and a primary urologic tumor is difficult due to similar morphology and histology, making the CDX-2 immunohistochemical maker expression an important tool to define the histopathology of the tumor.

Ictericia obstructiva secundaria a un pseudoaneurisma de arteria mesentérica superior / Obstructive jaundice secondary to a pseudoaneurysm of the superior mesenteric artery

Los pseudoaneursimas de arteria mesentérica superior son una entidad rara, generalmente asintomáticos pero que pueden debutar con dolor abdominal, masa pulsátil o shock, siendo excepcional la ictericia como forma de presentación. El diagnóstico se realiza mediante pruebas de imagen (TC) y en la actualidad el abordaje endovascular es el más extendido reservándose la cirugía abierta en casos seleccionados. Describimos el caso de una paciente con un pseudoaneurisma de la AMS de 86mm con compresión de la vía biliar extrahepática. (AU)

Obstructive jaundice secondary to a pseudoaneurysm of the superior mesenteric artery.

Superior mesenteric arteries pseudoaneurysms are rare entity, usually asymptomatic but they can appear as an abdominal pain, throbbing mass or shock, being jaundice an exceptional type of presentation. Diagnosis is made by imaging tests (CT) and currently the endovascular approach is the most widespread, reserving open surgery in selected cases. We describe the case of a patient with an 86mm SMA pseudoaneurysm with compression of the extrahepatic bile duct.

Sigmoid colon Schwannoma simulating colon cancer.

Schwannomas tumours are uncommonly developed in the gastrointestinal tract (2-6%), located in 12% of cases in small and large intestines. An 87-year-old woman was studied due to epigastric pain and dyspepsia. CT scan and colonoscopy showed a neoplastic process in the sigmoid colon. It was performed an oncologic laparoscopic sigmoidectomy. Histological study described a schwannoma and a positive immunohistochemistry to S-100. The diagnostic challenge is that this is a submucosa lesion, therefore, endoscopy biopsy is realized only in the mucosa. This becomes the differential diagnostic very difficult in order to differentiate from another mesenchymal tumor (GIST or leiomyoma). The immunohistochemistry helps in the diagnostic if it is positive to S- 100 and negative to C-KIT, CD-34, actine and desmine (findings of GIST tumors and leiomyoma). In conclusion, schwannoma diagnostic is tough. Those are asymptomatic tumors with nonspecific radiological findings. Diagnostic confirmation is a S-100 positive immunohistochemistry in the histological study.

Cytomegalovirus colitis seems to be colon cancer. HIV debut.

Cytomegalovirus (CMV) infection is very common in immunosuppressed patients. It can y puede afectar a todo el tracto gastrointestinal, presentándose como úlceras o pseudotumores. A 43-year-old male with no personal background of interest, was studied due to constitutional syndrome. The diagnosis was neoplasia of the right colon, reported by colonoscopy and CT scan. A right hemicolectomy was performed with oncologic character. The definitive histology was CMV infectious colitis with positive immunohistochemical staining. Treatment with ganciclovir was started and the patient was diagnosed with HIV infection. The unusual finding of CMV infection as a pseudotumor can simulate, clinically and radiologically, a colonic neoplasm. It has been described in the literature in patients immunocompromised by HIV; however, the absence of risk factors means that it can be confused with a primary neoformative process.

Linfoma de Hodgkin anal primario y tumor neuroendocrino intestinal sincrónicos: a propósito de un caso y revisión de la literatura / Primary rectal Hodgkin's lymphoma and synchronous small bowel neuroendocrine tumor: Case report and literature review

Resumen La localización extranodal gastrointestinal del linfoma de Hodgkin comprende el 5% de todos los linfomas. Dentro de este grupo, el linfoma anal primario representa menos del 0,05%, siendo por tanto una entidad extremadamente rara. Por otro lado, los tumores neuroendocrinos son un grupo heterogéneo de neoplasias relativamente poco frecuentes, pero de localización fundamentalmente digestiva. La asociación entre un linfoma de Hodgkin de localización anal y un tumor neuroendocrino intestinal no ha sido descrita previamente en la literatura, pero no es en absoluto raro que los tumores neuroendocrinos puedan coexistir con otro tipo de neoplasias. Los autores presentan el caso infrecuente de presentación de linfoma Hodgkin de localización anal asociado a un tumor neuroendocrino intestinal en una paciente mujer de 74 años, describiéndose la clínica, resultados de pruebas complementarias y tratamiento recibido.

Abstract Extranodal gastrointestinal Hodgkin's lymphoma comprises 5% of all lymphomas. In this group, primary rectal lymphoma represents less than 0.05%; thus, it is an extremely rare entity. On the other hand, neuroendocrine tumors are a heterogeneous group of infrequent neoplasms, mainly of digestive location. The association between a rectal Hodgkin's lymphoma and an intestinal neuroendocrine tumor has not been previously described in the literature, but it is not at all uncommon for neuroendocrine tumors to coexist with other types of neoplasms. The authors present a rare case of rectal Hodgkin's lymphoma associated with an intestinal neuroendocrine tumor in a 74-year-old female patient, describing the symptoms, complementary test results, and treatment.

Linfoma MALT de localización colónica: a propósito de un caso y revisión de la literatura / Colonic MALT Lymphoma. Case report and literature review

Resumen El linfoma MALT es una forma poco frecuente de linfoma no Hodking de células B de bajo grado, que se desarrolla a expensas del tejido linfoide de las membranas mucosas. La localización más frecuente a nivel gastrointestinal es el estómago relacionando con la infección por Helicobacter pylori. El linfoma MALT colónico es una entidad extremadamente rara y cuya incidencia no supera el 5% de los casos en países asiáticos, con series porcentualmente menores al 2,5%, siendo la ubicación de este tipo de linfoma la más inusual de todo el tracto digestivo en comparación con otras neoplasias malignas que afectan al colon. Los autores exponen el caso infrecuente de presentación de linfoma tipo MALT de localización colónica en un paciente varón de 51 años, describiendo la clínica, los resultados de pruebas complementarias y el tratamiento recibido por el paciente.

Abstract MALT lymphoma is a rare form of low-grade non-Hodking B-cell lymphoma, which develops at the expense of lymphoid tissue of the mucous membranes. The most frequent location at the gastrointestinal level is the stomach related to the infection by Helicobacter pylori. Colonic MALT lymphoma is an extremely rare entity and the incidence of which does not exceed 5% of cases in Asian countries, with a series of less than 2.5%, with the location of this type of lymphoma being the most unusual of the entire digestive tract compared to other malignant neoplasms that affect the colon. The authors present the infrequent case of presentation of MALT-type lymphoma of colonic location in a 51-year-old male patient, describing the clinic, the results of complementary tests and the treatment received by the patient.

Carcinoma neuroendocrino rectal: Una neoplasia infrecuente / Neuroendocrine rectal carcinoma: An infrequent tumor

Resumen El carcinoma neuroendocrino (CNE) es una entidad infrecuente encontrándose usualmente al diagnóstico en estadios avanzados. El tratamiento suele ser combinado, quirúrgico junto a quimiorradioterapia. Presentamos el caso de una mujer de 73 años estudiada por síndrome constitucional y rectorragias. Tras completar estudios fue diagnosticada de CNE rectal pobremente diferenciado a 5 cm del margen anal con adenopatías mesorrectales. Inicio quimioterapia de inducción con respuesta parcial y se realizó resección anterior de recto ultrabaja con anastomosis primaria e ileostomia en asa derivativa, con histología de CNE de células grandes pT2N0 Mx. Posteriormente recibió quimioterapia adyuvante. El CNE rectal es una neoplasia rara, presente entre la 4o-7o década de la vida y con sintomatología similar al adenocarcinoma colorrectal, siendo un tumor poco diferenciado y muy agresivo. El papel de la neo adyuvancia es fundamental dado que suele ser una enfermedad avanzada al diagnóstico, disminuye el tamaño del tumor primario y permite realizar posteriormente resecciones oncológicas.

Abstract Neuroendocrine carcinoma (NC) is an infrequent pathology that is usually found in the advanced stages. The treatment is surgery, and combined chemotherapy andradiotherapy. A 73-year old woman was being studied for constitutional syndrome and rectal bleeding. After which, she was diagnosed with a poorly differentiated rectal NC, 5 cm from de anal margin with mesorectal lymph nodes. Induction chemotheraphy was started with partial response. A low anterior resection of rectum was performed with primary anastomoses and diverting loop ileostomy. The histology result was a large-cell NC, staged as pT2N0 Mx. She then received adjuvant chemotherapy. Rectal NC is infrequent, and usually presents between the fourth and seventh decade of life. Its symptoms are similar to colorectal adenocarcinoma, but it has a lower grade of differentiation, and is more aggressive. Neoadjuvant treatment is essential as it usually a metastatic disease at diagnosis, and helps to decrease the tumor size, and allows oncological surgery to be performed later.

Estenosis rectal inflamatoria secundaria a Chlamydia trachomatis: a propósito de un caso / Rectal inflammatory stenosis secondary to Chlamydia trachomatis: a case report

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Rectal inflammatory stenosis secondary to Chlamydia trachomatis: a case report.

The rectal inflammatory originated strictures constitute a rare cause of intestinal obstruction. We present a 30-year-old male patient with a history of HIV and protctitis caused by Chalmydia trachomatis and HSV-2, in which develops a low intestinal obstruction refractory to medical treatment. Surgery was performed with good clinical evolution. The medical treatment constitutes the fundamental basis of the therapy in these patients. Despite that, when fibrotic stenoses are not treatable medical or endoscopically, they often require surgical treatment. We must pay attention to the proctitis infectious diseases as a cause of rectal stenosis, especially by Chlamydia trachomatis, and assess surgical option in refractory cases.

Endosalpingiosis como una entidad obstructiva simuladora de neoplasia de sigma / Endosalpingiosis as an obstructive entity simulating a sigma neoplasm

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