Transanal endoscopic microsurgery for the treatment of uncommon rectal lesions. / Microcirugía endoscópica transanal en el tratamiento de lesiones rectales atípicas.

INTRODUCTION: Transanal endoscopic microsurgery (TEM) was developed as a less aggressive alternative treatment for rectal lesions (mainly adenomas and adenocarcinomas). However, its use for other rectal lesions has become more frequent, trying to reduce the morbidity associated with more invasive techniques. The aim of this study is to describe our experience in the use of TEM in other rectal lesions. METHODS: Retrospective and descriptive study including patients operated with TEM (from June 2008 to December 2016) for the treatment of rectal lesions different from adenomas or adenocarcinomas. RESULTS: Among the 138 patients treated by TEM in our department, 10 patients were operated on for rectal lesions other than adenomas or adenocarcinomas. Rectal lesions were 3neuroendocrine tumours, a neuroendocrine tumour metastasis, a rectal stenosis, a cloacogenic polyp, an endometrioma, a retrorrectal tumour, a presacral abscess and a lesion in the rectovaginal septum. Mean operative time was 72min and postoperative stay was 4.2 days. Only one patient needed a reoperation, due to rectal bleeding. CONCLUSIONS: TEM could be a useful tool for the treatment of rectal lesions different from adenomas or adenocarcinomas, potentially decreasing the morbidity associated with more aggressive surgical techniques.

Microcirugía endoscópica transanal en el tratamiento de lesiones rectales atípicas / Transanal endoscopic microsurgery for the treatment of uncommon rectal lesions

Introducción: La microcirugía endoscópica transanal (TEM) se diseña como una alternativa menos agresiva en el tratamiento de lesiones rectales (principalmente adenomas y adenocarcinomas). Sin embargo, su uso se ha ampliado a otras lesiones rectales para intentar disminuir la morbilidad añadida a técnicas más invasivas. El objetivo de este estudio es mostrar nuestra experiencia en el uso de la TEM en el tratamiento de otras lesiones rectales, diferentes de adenomas y adenocarcinomas. Métodos: Estudio retrospectivo descriptivo en el que se incluyen pacientes intervenidos mediante TEM para el tratamiento de lesiones rectales (diferentes a adenomas o adenocarcinomas) desde junio de 2008 hasta diciembre de 2016. Resultados: Entre los 138 pacientes operados mediante TEM en nuestro servicio, 10 fueron tratados por lesiones diferentes a adenomas o adenocarcinomas. Las lesiones rectales fueron 3tumores neuroendocrinos primarios, una metástasis de tumor neuroendocrino, una estenosis rectal, un pólipo cloacogénico, un endometrioma, un tumor retrorrectal, un absceso presacro y una lesión sin filiar en tabique rectovaginal. El tiempo operatorio medio fue de 72 min y la estancia postoperatoria de 4,2 días. Solo un paciente necesitó reintervención por rectorragia. Conclusiones: La aplicación del TEM para el tratamiento de lesiones rectales diferentes a adenomas o adenocarcinomas puede ser una herramienta útil que potencialmente ayude a disminuir la morbilidad asociada a otros tipos de técnicas quirúrgicas más invasivas (AU)

Introduction: Transanal endoscopic microsurgery (TEM) was developed as a less aggressive alternative treatment for rectal lesions (mainly adenomas and adenocarcinomas). However, its use for other rectal lesions has become more frequent, trying to reduce the morbidity associated with more invasive techniques. The aim of this study is to describe our experience in the use of TEM in other rectal lesions. Methods: Retrospective and descriptive study including patients operated with TEM (from June 2008 to December 2016) for the treatment of rectal lesions different from adenomas or adenocarcinomas. Results: Among the 138 patients treated by TEM in our department, 10 patients were operated on for rectal lesions other than adenomas or adenocarcinomas. Rectal lesions were 3neuroendocrine tumours, a neuroendocrine tumour metastasis, a rectal stenosis, a cloacogenic polyp, an endometrioma, a retrorrectal tumour, a presacral abscess and a lesion in the rectovaginal septum. Mean operative time was 72min and postoperative stay was 4.2 days. Only one patient needed a reoperation, due to rectal bleeding. Conclusions: TEM could be a useful tool for the treatment of rectal lesions different from adenomas or adenocarcinomas, potentially decreasing the morbidity associated with more aggressive surgical techniques (AU)

Inclusiones glandulares benignas en ganglios centinelas de carcinoma de mama como causa de falsos positivos. Descripción de un caso y revisión de la literatura / Benign glandular inclusions in the sentinel nodes of breast cancer as a cause of false-positive diagnosis. A case report and literature review

Las inclusiones glandulares benignas de mama son entidades poco frecuentes y su presencia en el estudio intraoperatorio del ganglio centinela en la cirugía del cáncer de mama, puede dar lugar a diagnósticos erróneos que conllevan linfadenectomías innecesarias con su morbilidad asociada. Presentamos el caso clínico de una paciente con cáncer de mama, en cuya intervención se remitió un ganglio centinela que originó un diagnóstico falso positivo de metástasis y que ilustra la necesidad de conocer este proceso (AU)

Benign glandular inclusions are rare events. Their presence in the intraoperative evaluation of the sentinel lymph node in breast carcinoma surgery can result in diagnostic error and lead to an unnecessary axillary lymph node dissection with an increased risk of associated morbidity. We report the case of a woman with breast carcinoma. During surgery, evaluation of the sentinel node led to a false-positive diagnosis of metastasis. We discuss the diagnostic problem illustrated by this case, as well as the importance of avoiding overtreatment (AU)