Type II intrapancreatic choledochal malignant cyst in adults: duodenopancreatectomy.

A 62-year-old female patient was admitted for abdominal pain and vomiting. Imaging tests revealed a solid-cystic lesion at the head of the pancreas communicating with the distal bile duct. A Todani type II choledochal cyst was diagnosed with neoplastic degeneration after cytological diagnosis with endoscopic ultrasound-guided puncture. The patient was treated with a cephalic duodenopancreatectomy with curative intention.

Nevus melanocítico atípico limbar. A propósito de un caso / Atypical melanocytic nevus of the limbus. A case report

CASO CLÍNICO: Mujer de 78 años que se presenta con una tumoración corneal no pigmentada y vascularizada en ojo izquierdo de dos meses de evolución y sin antecedentes oftalmológicos. Se realizó exéresis y estudio histopatológico con diagnóstico de nevus melanocítico atípico limbar. DISCUSIÓN: La pigmentación corneal procede, en la mayoría de los casos, de la extensión de lesiones de conjuntiva y limbo, o de la migración de sus melanocitos tras una agresión corneal previa. Debemos realizar biopsia y estudio anatomopatológico puesto que, aunque debemos descartar enfermedad precancerosa y maligna (melanosis adquirida primaria y melanoma conjuntival), también existen condiciones benignas como el caso que nos ocupa

CASE REPORT: A 78-year-old-woman presented with a corneal non-pigmented vascularised tumour of her left eye, of 2 months onset, but with no previous ocular disorders. Surgical excision was performed, and the histopathological study showed the lesion to be an atypical melanocytic nevus of the limbus. DISCUSSION: Corneal pigmented lesions tend to occur as a result of conjunctival or sclerocorneal limbus lesions spreading or arising de novo from melanocytic cells that have migrated following corneal injury. A biopsy should be carried out to type and distinguish benign lesions (nevus) from pre-malignant or malignant lesions (primary acquired melanosis or conjunctival melanoma)

[Atypical melanocytic nevus of the limbus. A case report]. / Nevus melanocítico atípico limbar. A propósito de un caso.

CASE REPORT: A 78-year-old-woman presented with a corneal non-pigmented vascularised tumour of her left eye, of 2 months onset, but with no previous ocular disorders. Surgical excision was performed, and the histopathological study showed the lesion to be an atypical melanocytic nevus of the limbus. DISCUSSION: Corneal pigmented lesions tend to occur as a result of conjunctival or sclerocorneal limbus lesions spreading or arising de novo from melanocytic cells that have migrated following corneal injury. A biopsy should be carried out to type and distinguish benign lesions (nevus) from pre-malignant or malignant lesions (primary acquired melanosis or conjunctival melanoma).

[Lepra: an uncommon cause of infectious neuropathy]. / Lepra: causa infrecuente de neuropatía potencialmente tratable.

INTRODUCTION: Lepra is an uncommon disease within our setting. However, it was considered the most frequent cause of polyneuropathy only 50 years ago. CASE REPORT: We present the case of a 37 year-old woman who consulted due to paresthesias in both hands and feet, livedo reticularis and complaints of frequent hand lesions. Examination of the skin detected nodular lesions and the neurophysiological study confirmed distal symmetric sensitive polyneuropathy with axonal predominance. The skin biopsy also showed histocytic infiltrate and mycobacterium lepra type intracytoplasmatic bacilli. This led to the diagnosis of Multibacillary lepromatous leprosy. Multiple treatment was begun, according to the World Health Organization recommendations, with good evolution. In spite of the attempts to eradicate lepra, its incidence continues to be elevated, especially in endemic areas, among which the south of Spain is included. It is generally associated to overcrowding and low social-economic level. CONCLUSIONS: This is the last endemic case in the Valencian Community. The possibility of lepra should be considered among the possible causes of sensitive polyneuropathy, above all in patients in endemic areas.

Lepra: causa infrecuente de neuropatía potencialmente tratable / Lepra: an uncommon cause of infectious neuropathy

Introducción. La lepra es una enfermedad poco frecuente en nuestro entorno; sin embargo, hace tan sólo 50 años era considerada la causa más frecuente de polineuropatía. Caso clínico. Presentamos el caso de una mujer de 37 años que consulta por parestesias en manos y pies, livedo reticularis y quejas de frecuentes ulceraciones en las manos. En la exploración cútanea se detectaron lesiones nodulares y el estudio neurofisiológico puso de manifiesto una polineuropatía sensitiva simétrica distal de predominio axonal. La biopsia cutánea mostró un infiltrado histocitario y bacilos intracitoplasmáticos de tipo Mycobacterium leprae, lo que condujo al diagnóstico de lepra lepromatosa multibacilar. Se instauró tratamiento con politerapia, según recomendaciones de la Organización Mundial de la Salud, con buena evolución. A pesar de los intentos de erradicación de la lepra, su incidencia continúa siendo elevada, especialmente en áreas endémicas, entre las que se incluye el sur de España y, generalmente, asociada a hacinamiento y bajo nivel socioeconómico. Conclusiones. Éste es el último caso autóctono comunicado en la Comunidad Valenciana. Entre las posibles causas de polineuropatía sensitiva debe tenerse en cuenta todavía la posibilidad de la lepra, sobre todo en pacientes procedentes de áreas endémicas (AU)

Introduction: Lepra is an uncommon disease within our setting. However, it was considered the most frequent cause of polyneuropathy only 50 years ago. Case Report: We present the case of a 37 year-old woman who consulted due to paresthesias in both hands and feet, livedo reticularis and complaints of frequent hand lesions. Examination of the skin detected nodular lesions and the neurophysiological study confirmed distal symmetric sensitive polyneuropathy with axonal predominance. The skin biopsy also showed histocytic infiltrate and mycobacterium lepra type intracytoplasmatic bacilli. This led to the diagnosis of Multibacillary lepromatous leprosy. Multiple treatment was begun, according to the World Health Organization recommendations, with good evolution. In spite of the attempts to eradicate lepra, its incidence continues to be elevated, especially in endemic areas, among which the south of Spain is included. It is generally associated to overcrowding and low social-economic level. Conclusions: This is the last endemic case in the Valencian Community. The possibility of lepra should be considered among the possible causes of sensitive polyneuropathy, above all in patients in endemic areas (AU)