RESUMO
Our paper studies the quite rare occurrence of the digestive superior occlusive pathology, namely some causes which might induce partial or even total obstruction of the digestive tract, at the distal anatomical limits of the duodenum, also known as the Treitz angle. The first two described cases were carcinoid tumors, obstructive and ulcerated in the lumen of the same angle. The last two cases were an obstructive leiomyosarcoma and an invasive mesenteric metastasis from a right colon cancer, which cause a total external compression of the Treitz angle, clinically manifested as a complete food intolerance, as a first symptom. Concerning the clinical evolution, these are totally different lesions, malign, metastasis and neuroendocrine tumors, which occurred at the same level, had a totally different clinical evolution and surgical approach, only three of them developing at good postoperative course. The imaging, clinical and pathological diagnosis problems, the different specific surgical solutions, the postoperative care and finally the rarity of this level of obstruction of the small bowel, are the aim of this paper.
Assuntos
Adenocarcinoma/cirurgia , Tumor Carcinoide/cirurgia , Neoplasias Duodenais/cirurgia , Neoplasias do Íleo/cirurgia , Leiomiossarcoma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Idoso , Tumor Carcinoide/diagnóstico , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/secundário , Neoplasias do Colo/cirurgia , Neoplasias Duodenais/diagnóstico , Evolução Fatal , Feminino , Humanos , Neoplasias do Íleo/diagnóstico , Leiomiossarcoma/diagnóstico , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Primárias Múltiplas/diagnósticoRESUMO
The juvenile laryngeal papillomatosis, a disease which in the absence of an adequate monitoring may have an invalidating character, represented for a long time a problem as regards both its treatment and its possible etiology. The use of monoclonal antibodies, as well as of molecular biology techniques, permitted to elucidate some aspects, such as the viral origin of the infection. Twenty five juvenile laryngeal papillomas, removed intra-operatively, were investigated immunohistochemically, a significant increase of the epidermal growth factor (EGF) receptor being found. Ten samples were also analyzed with the PCR technique, for the purpose of detecting the presence of the corresponding DNA sequences of human papillomaviruses (HPV): all were positive. The HPV genotyping showed the presence of only the HPV6 and 11 genotypes.
