[Permanent tunneled drainage for malignant ascites: initial experience with the PleurX® catheter]. / Drenaje permanente tunelizado de la ascitis maligna: experiencia inicial con el catéter PleurX®.

OBJECTIVE: The most common treatment in recurrent malignant ascites is generally temporary peritoneal drainage. We present our experience in placing permanent tunneled catheters in a series of patients and analyze the safety and efficacy of the treatment. MATERIAL AND METHODS: We used total aseptic measures in the interventional ultrasonography suite to place permanent tunneled catheters in 10 patients under ultrasonographic guidance and local anesthesia. RESULTS: The catheters remained patent for a median of 52 days in the nine patients who died. In one of these, the catheter was withdrawn while still patent due to generalized sepsis. At the end of the study, one patient still had a permeable catheter 124 days after placement. CONCLUSION: Although the low number of patients in our series precludes generalizations, tunneled peritoneal catheters seem to be a safe and effective minimally invasive treatment for malignant ascites in terminal oncologic patients. This approach facilitates the draining of the ascites at home, obviating the need for repeated hospital visits and punctures and the risks involved therein. Nevertheless, further experience and prospective randomized trials are necessary.

[Fatal pulmonary embolism after embolization of a hepatocellular carcinoma using microspheres]. / Embolismo pulmonar fatal tras la embolización con microsferas de un hepatocarcinoma.

Intra-arterial treatment has become a first-line alternative in the therapeutic arsenal against primary and metastatic hepatic tumors. Despite its proven safety and efficacy, intra-arterial treatment with lipiodol, chemotherapy, and particles carries the risk of complications, some of which can be lethal. We present the case of a 32-year-old woman with multifocal hepatocellular carcinoma treated with microsphere embolization. After the second session, the patient died of a pulmonary embolism composed of particles and tumor cells.

[Arterial microcoil embolization in high flow priapism]. / Embolización arterial con microcoils en priapismo de alto flujo.

High flow priapism occurs mainly as a result of a posttraumatic arteriocavernous fistula. Treatment aims to seal the fistula without damaging erectile function. Of all the available treatments, supraselective embolization of the lacerated artery achieves optimal sealing of the fistula with minimal damage to the surrounding tissues. There is no consensus regarding the best materials to be used. Although reabsorbable materials have traditionally been the most commonly used, it is also possible to achieve adequate resolution of the priapism with adequate conservation of erectile function using non-reabsorbable materials, especially microcoils. We describe two cases of patients with high flow priapism caused by bilateral arteriocavernous fistulas treated using microcoil embolization.

Metastases to the breast: a review of 33 cases.

The aim of the study was to show the clinical and radiological manifestations of metastases to the breast (MB). From 1987 to 2006, 33 patients with MB were diagnosed at our institution. Their clinical and radiological features were retrospectively evaluated. Of the 33 cases, 31 presented as a palpable breast lump. On mammography, their findings were classified as follows: well-circumscribed masses (11 cases), ill-circumscribed masses (five), focal asymmetric densities (one) and inflammatory skin changes (six). Mammograms were normal in six cases (all of them showed dense breast tissue). Four CT scans showed two well-circumscribed masses and two ill-circumscribed masses. Ultrasonography was available in 18 cases: hypoechoic lesions (15 cases) were more frequent than hyperechoic (one) or isoechoic lesions (two). The appearance on magnetic resonance was similar to primary breast cancer (one case). The most common primary tumours causing MB were haematological malignancies (nine cases) and melanomas (seven). Metastases to the breast showed a wide range of mammographic and ultrasonographic appearances, resembling both benign and malignant lesions. Any patient who presents with a breast lump with a history of cancer should undergo a core-needle biopsy in order to determine the histology of the lump.

[Mammographic findings in microcalcifications associated with breast cancer after neoadjuvant chemotherapy]. / Hallazgos mamográficos en las microcalcificaciones asociadas a cáncer de mama tras quimioterapia neoadyuvante.

OBJECTIVE: To evaluate the mammographic findings in microcalcifications associated with breast cancer after neoadjuvant chemotherapy. MATERIAL AND METHODS: From January 2000 to May 2005, a total of 99 breast cancer patients underwent neoadjuvant chemotherapy. Ten patients had microcalcifications on mammograms prior to treatment. We evaluated the evolution of the tumor and of the microcalcifications, correlating the imaging findings with the clinical and histological manifestations. RESULTS: Four different patterns of evolution were observed for the microcalcifications: the number of particles increased in two cases, remained stable in three, decreased in four, and in one patient the microcalcifications disappeared. The size of the tumor decreased in all cases. CONCLUSIONS: After neoadjuvant chemotherapy microcalcifications can evolve unpredictably and independently of tumor response.

[Fourth branchial cyst within the thyrohyoid membrane: a difficult differential diagnosis with mixed laryngocele]. / Quiste del cuarto arco branquial en la membrana tirohioidea: un difícil diagnóstico diferencial con el laringocele mixto.

We present a case of a 62-year-old female patient with a right latero-cervical mass and an enlarged arytenoepiglottic fold, that caused voice disturbances. Computed tomography of the neck depicted an unilocular and homogeneous well-defined cyst located in the right parapharyngeal space that extended through the thyrohyoid membrane. It was initially diagnosed of mixed laryngocele. During surgical resection, no connexion between the lesion and laryngeal ventricle was detected, so the final diagnosis was branchial cyst. We discuss the pathogenicity and clinical, radiological and histological findings that facilitate differential diagnosis between mixed laryngocele and branchial cysts, mainly those derived from the second and fourth clefts. The radiological and histological findings in both lesions may be similar, so only the communication with the larynx, or its absence, can solve diagnostic doubts, course.

[Adenoid cystic carcinoma of the breast]. / Carcinoma adenoide quístico de mama.

OBJECTIVE: To review the clinical presentation and imaging findings of adenoid cystic carcinoma (ACC). MATERIAL AND METHODS: We performed a retrospective study of the period between January 1990 and July 2004, comprising five cases of ACC of the breast, all in women, among 4,036 malignant lesions diagnosed (0.12%). We reviewed the available imaging studies (mammography in all five cases, ultrasound in four, and magnetic resonance in one). We also reviewed the clinical presentation and evolution in all patients. RESULTS: Three patients presented with palpable lesions. Mammographic findings consisted of irregular, ill-defined nodules in three cases, a well-defined rounded nodule in one, and an asymmetrical density in the other. No microcalcifications were observed in any case. Ultrasound examination showed ill-defined polylobulated nodules in three cases and a well-defined, rounded nodule with small cysts inside in the remaining case that showed intense vascularization in the Doppler study. The only case studied by magnetic resonance was seen as a rounded nodule that showed heterogeneous contrast uptake, well-defined margins, and an enhancement curve considered highly suspicious for malignancy. Treatment was tumorectomy together with radiotherapy in all cases. Four patients remain asymptomatic at present (mean follow-up = 64 months) and one presented lung and liver metastes twelve years after the diagnosis of ACC. CONCLUSION: ACC is an uncommon breast tumor with varied radiologic appearance, although moderately or highly suspicious lesions predominate. We consider the absence of microcalcifications in these tumors to be noteworthy. The prognosis is generally good, although the possibility of remote metastasis exists.