ABSTRACT
BACKGROUND: Solid tumors are a common cause of secondary thrombocytosis, which has been identified as a prognostic factor in various cancers. However, the impact of thrombocytosis on the prognosis of gastric cancer is not yet well defined. The aim of this study was to assess the prevalence and prognostic value of thrombocytosis in patients with gastric cancer. METHODS: This was a retrospective study of patients with gastric carcinoma treated surgically, with curative intent, in our hospital, Centro Hospitalar Vila Nova de Gaia/Espinho, between January 2009 and December 2019. Clinical files were consulted and clinicopathological characteristics were analyzed. RESULTS: In the present sample (n = 352), the prevalence of pretreatment thrombocytosis was 16.5%. Thrombocytosis was associated with more advanced T stage, greater number of metastatic nodes, and more frequent lymphatic and venous permeation. The presence of thrombocytosis had a negative impact on disease-free survival (hazard ratio [HR] 3.54, 95% confidence interval [CI] 2.35-5.33, P < .001) and overall survival (HR 4.45, 95% CI 2.95-6.71, P < .001). CONCLUSIONS: The presence of pretreatment thrombocytosis had a negative impact on overall survival and disease-free survival and thus could be used as an independent prognostic factor.
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Humans , Male , Female , Middle Aged , Aged , Lipoma/surgery , Intestinal Neoplasms/surgery , Ligation , Treatment Outcome , CauteryABSTRACT
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Humans , Female , Aged , Intestinal Perforation/diagnosis , Endoscopy, Gastrointestinal/methods , Foreign-Body Migration/complications , Risk FactorsSubject(s)
Endoscopy , Foreign Bodies/diagnosis , Intestinal Perforation/therapy , Aged , Female , Humans , Intestinal Perforation/diagnosisABSTRACT
INTRODUCTION: Intestinal angioedema is a rare adverse effect of angiotensin converting enzyme inhibitors. CLINICAL CASE: A 42-year old woman presented to the Emergency Department complaining of diffuse abdominal pain, predominantly in the right quadrants, with no other associated symptoms. She had been started on perindopril plus indapamide 72 h before the admission for arterial hypertension. There was no other relevant background. Physical examination suggested peritoneal irritation on the lower quadrants of the abdomen and right flank. Laboratory tests were relevant for mild leukocytosis. Abdomen ultrasound and contrast-enhanced computed tomography scan showed moderate amount of fluid in the pelvic excavation and small intestine wall thickening. She was admitted for observation. Once the hypothesis of intestinal angioedema was admitted, angiotensin converting enzyme inhibitor was withheld and no other-directed therapy was instituted. Within 24 h she showed clinical, analytic and imaging improvement, thus supporting this diagnosis. CONCLUSION: The diagnosis of intestinal angioedema induced by angiotensin converting enzyme inhibitor can be challenging and time consuming due to its rarity and nonspecific symptoms, which may lead to underdiagnosis of this entity.
INTRODUÇÃO: O angioedema intestinal é um efeito adverso raro dos inibidores da enzima de conversão da angiotensina. CASO CLÍNICO: Sexo feminino, 42 anos, recorreu ao Serviço de Urgência por dor abdominal difusa predominante nos quadrantes direitos, sem outra sintomatologia. Tinha iniciado perindopril e indapamida 72 horas antes por hipertensão arterial. Sem outros antecedentes de relevo. Ao exame objetivo salientava-se apenas sinais de irritação peritoneal à palpação da fossa ilíaca e flanco direitos. Analiticamente evidenciava discreta leucocitose, sem outras alterações. A ecografia e tomografia computorizada contrastada abdominal revelaram líquido moderado na escavação pélvica e espessamento das paredes do delgado. Foi internada para vigilância. Admitindo-se angioedema intestinal, o inibidor da enzima de conversão da angiotensina foi suspenso e não foi instituída qualquer outra terapêutica dirigida. Em 24 horas, verificou-se melhoria clínica, analítica e imagiológica, corroborando a hipótese de diagnóstico. CONCLUSÃO: O diagnóstico de angioedema intestinal por inibidor da enzima de conversão da angiotensina é, por vezes, difícil e moroso pela sua raridade e inespecificidade dos sintomas, podendo conduzir ao subdiagnóstico desta entidade.
Subject(s)
Cecum , Colonoscopy/methods , Ileal Neoplasms/surgery , Lipoma/surgery , Female , Humans , Ileal Neoplasms/diagnosis , Ligation , Lipoma/diagnosis , Middle Aged , ProlapseABSTRACT
Cystic duct carcinoma was defined by Farrar as a tumour restricted to the cystic duct, making it a rare disease. The authors describe a case of a cystic duct carcinoma that fulfils Farrar's strict diagnostic criteria and that became clinically relevant by compressing the common hepatic duct, thus causing cholestasis. A cholecystectomy was performed with en bloc resection of the cystic and extrahepatic bile duct with a regional lymphadenectomy.
Subject(s)
Bile Duct Neoplasms/diagnosis , Cystic Duct , Bile Duct Neoplasms/complications , Bile Duct Neoplasms/surgery , Cholangiopancreatography, Magnetic Resonance , Cholecystectomy , Cholestasis/etiology , Constriction, Pathologic/complications , Cystic Duct/surgery , Diagnosis, Differential , Female , Hepatic Duct, Common/pathology , Humans , Middle AgedABSTRACT
Pancreaticopleural fistula is an uncommon complication of pancreatitis. The authors describe a case of a man in his mid-40s with a history of alcohol abuse, who presented with dyspnoea and whose chest X-ray revealed a massive left pleural effusion. Further diagnostic work up revealed a pancreaticopleural fistula. There was no improvement with a conservative approach and endoscopic treatment was not feasible, leading to the need for a surgical intervention.
Subject(s)
Pancreatic Fistula/diagnosis , Pancreatic Fistula/etiology , Pancreatitis/complications , Respiratory Tract Fistula/diagnosis , Respiratory Tract Fistula/etiology , Adult , Cholangiopancreatography, Magnetic Resonance , Diagnosis, Differential , Dyspnea/etiology , Humans , Male , Pancreas/pathology , Pancreas/surgery , Pancreatic Fistula/surgery , Pleura/pathology , Pleura/surgery , Pleural Diseases/diagnosis , Pleural Diseases/etiology , Pleural Diseases/surgery , Pleural Effusion/etiology , Respiratory Tract Fistula/surgeryABSTRACT
Neuroendocrine breast cancer is thought to account for about 1% of all breast cancers. This rare type of breast malignancy is more common in older women and presents as a low-grade, slow-growing cancer. The most definitive markers that indicate neuroendocrine carcinoma are the presence of chromogranin, synaptophysin or neuron-specific enolase, in at least 50% of malignant tumour cells. The authors present a case report of an 83-year-old woman, admitted to their institution with right breast lump. Physical examination, mammography and ultrasonography showed a 2.4 cm nodule, probably a benign lesion (BI-RADS 3). A fine needle aspiration biopsy was performed and revealed proliferative epithelial papillary lesion. She was submitted to excisional biopsy and histology showed endocrine breast cancer well differentiated (G1). Immunohistochemically, tumour cells were positive for synaptophysin. These breast cancers are characterised for their excellent prognosis and conservative treatment is almost always enough to obtain patient cure.
Subject(s)
Breast Neoplasms/pathology , Neuroendocrine Tumors/pathology , Synaptophysin/analysis , Aged, 80 and over , Antineoplastic Agents, Hormonal/therapeutic use , Biopsy , Breast Neoplasms/chemistry , Breast Neoplasms/drug therapy , Female , Humans , Mammography , Neuroendocrine Tumors/chemistry , Neuroendocrine Tumors/drug therapyABSTRACT
Interruption of the inferior vena cava with azygos continuation is an uncommon vascular anomaly that results from aberrant development during embryogenesis. We report a case of this anomaly in a young boy of 19 years old sent for our observation for presenting an hipotransparency in the chest x-ray, which study revealed a prominence of the azygos cross. Further evaluation by CT-scans disclosed the diagnosis of congenital absence of the inferior vena cava, associated to multiple spleens (polispleenism).
