Hemangiopericitoma en el cuello / Hemangiopericytoma in the Neck

Introducción: El hemangiopericitoma es un raro tumor mesenquimal (vascularizado y potencialmente maligno) derivado de los pericitos, que puede aparecer en cualquier parte del cuerpo; sin embargo, en el cuello se describen casos aislados. La resección quirúrgica completa constituye la piedra angular del tratamiento. Objetivo: Presentar un caso de un hemangiopericitoma en el cuello, como un caso inusual, con potencial maligno desconocido, diagnóstico y tratamiento oportuno. Presentación de caso: Paciente de sexo masculino, de 39 años de edad, sin antecedentes de enfermedad conocidos, con una masa perceptible a nivel V del cuello derecho. Estudios de imagen muestran un tumor vascularizado de aproximadamente 6 x 7 x 6 cm, entre los músculos escalenos, que fue originado en la arteria cervical profunda. Se confirmó mediante biopsia incisional el hemangiopericitoma, el cual fue tratado mediante resección tumoral completa y radioterapia adyuvante. Actualmente el paciente no tiene actividad tumoral después de su tratamiento inicial. Conclusiones: El hemangiopericitoma en el cuello es raro, el diagnóstico constituye un reto clínico e histológico, ya que, al ser poco común, su potencial maligno resulta desconocido. Aquellos tumores que tienen bajo grado de malignidad pueden ser controlados, de acuerdo a su localización y tamaño, mediante resección completa; mientras que los tumores de alto grado pueden recurrir y dar origen a metástasis. Nuestro paciente tuvo características histopatológicas con invasión capsular, lo que trajo como consecuencia un incremento del riesgo de recurrencia local. Por ese motivo, se decidió aplicar tratamiento adyuvante con radioterapia. El paciente se mantiene sin recurrencia tumoral local y a distancia después de 9 años de vigilancia médica(AU)

Introduction: Hemangiopericytoma is a rare mesenchymal tumor (vascularized and potentially malignant) derived from pericytes. It can occur anywhere in the body; however, isolated cases are described in the neck. Complete surgical resection is the cornerstone of treatment. Objective: To present a case of hemangiopericytoma in the neck, as an unusual case, with unknown malignant potential, as well as its timely diagnosis and treatment. Case presentation: A 39-year-old male patient, with no known history of disease, had a noticeable mass at the V level of the right neck. Imaging studies showed a vascularized tumor of approximately 6 x 7 x 6 cm, between the scalene muscles, which originated in the deep cervical artery. Hemangiopericytoma was confirmed by incisional biopsy, as well as treated by complete tumor resection and with adjuvant radiotherapy. Currently, the patient has no tumor activity after his initial treatment. Conclusions: Hemangiopericytoma in the neck is rare. Its diagnosis is a clinical and histologic challenge because, being uncommon, its malignant potential is unknown. Those tumors with low-grade malignancy can be controlled, according to their location and size, by complete resection; while high-grade tumors may recur and give rise to metastases. Our patient had histopathologic features with capsular invasion, which resulted in an increased risk of local recurrence. For this reason, adjuvant treatment with radiotherapy was decided to be applied. The patient remains without local or distant tumor recurrence after 9 years of medical surveillance(AU)

Tratamiento actual de la acalasia, reporte de un caso y revisión de la literatura / Current treatment of achalasia. A case report and literature review

Resumen: Presentamos el caso de una joven de 16 años con síntomas digestivos, principalmente disfagia y dolor retroesternal. Luego de ser diagnosticada de acalasia (sintomatología compatible), que se confirma por manometría de alta resolución, se indica tratamiento quirúrgico (miotomía de Heller + funduplicatura de Toupet), con cirugía mínimamente invasiva (laparoscopia), La evolución fue muy favorable: desaparecieron los síntomas digestivos y fue notable la pronta recuperación. Se revisa la literatura de las distintas opciones terapéuticas y sus principales indicaciones. Palabras claves: acalasia, manometría de alta resolución, miotomía de Heller, funduplicatura de Toupet

Abstract: We report the case of 15 year old female with digestive symptoms, mainly dysphagia and chest pain. After being diagnosed with possible achalasia (compatible clinical), is confirmed by high-resolution manometry, surgical treatment is indicated (myotomy heller + fundoplication toupet), with minimally invasive surgery (laparoscopy), with a very favorable evolution, disappearing digestive symptoms and produced a remarkable recovery in a short time. We do a literature review of therapeutic options available and their main indications. Key words: achalasia, high-resolution manometry, Heller myotomy, Toupet fundoplication

Laparoscopic enucleation of an esophageal leiomyoma.

BACKGROUND: Leiomyoma is the most common benign esophageal tumor that originates in the muscular layer, with the most common site located in the distal third of the esophagus. Its growth causes symptoms due to partial obstruction of the esophageal lumen, leading to the diagnosis and subsequent treatment. Today, due to modern minimally invasive surgical techniques, complete removal of these tumors can be accomplished with minimal morbidity and excellent results. CASE REPORT: We report the case of a 49-year-old female with a history of dysphagia, epigastric pain, and halitosis. She was diagnosed with a benign tumor originating from the muscular layer of the distal esophagus. Multiple biopsies had previously been taken, without histological confirmation. The patient underwent surgery where complete tumor enucleation was done laparoscopically. CONCLUSIONS: Preoperative diagnosis of these tumors should be based on clinical history and studies such as esophagoscopy and endoscopic ultrasound. Laparoscopic enucleation is the treatment of choice for leiomyomas of the esophagogastric junction. Biopsy specimens should be avoided because histology is not always possible. Furthermore, they are related to rupture of the esophageal mucosa during surgical treatment. After enucleation in selected patients, anti-reflux procedure should be carried out in order to protect the area of surgical resection and prevent complications from weakening the lower esophageal sphincter, as well as to resolve reflux symptoms.

[Peritoneal metastases of medulloblastoma due to placement of ventriculoperitoneal shunt in an adult patient].

BACKGROUND: Medulloblastoma is a highly aggressive tumor of the posterior fossa. It is more common in children and has a very low incidence in adults. This tumor may cause endocranial hypertension, which requires placement of a ventriculoperitoneal shunt after surgical resection. It is possible, however, that neoplastic cells found in the cerebral spinal fluid can migrate through the shunt and implant themselves into the peritoneal cavity, producing multiple metastases that create great difficulty in treatment and offer a poor prognosis. This event is extraordinarily rare, which explains the few published cases and the lack of guidelines for treatment. CLINICAL CASE: We present a 26-year-old male with a history of medulloblastoma of the cerebellum that was treated by complete tumor resection, radiotherapy and placement of a ventriculoperitoneal shunt. Two years later the patient demonstrated severe abdominal pain caused by the presence of multiple irresectable tumors in the abdomen and pelvis. A percutaneous biopsy documented metastatic medulloblastoma and the patient was treated with neoadjuvant chemotherapy based on schemes used for pediatric patients. There was a significant reduction in tumor activity that later allowed complete tumor resection. CONCLUSIONS: In adult patients, peritoneal metastases from medulloblastoma are an unusual event. With this surgical and clinical case, we can suggest new guidelines for diagnosis and treatment to obtain satisfactory results.

Solid mature ovarian teratoma with intrarectal protusion: case report.

BACKGROUND: Primary rectal teratoma is a very rare entity. It has been suggested that these tumors grow from aberrant germinal cells of the embryonic digestive tract. Ovarian tumor can also erode the rectal wall, allowing the formation of a fistula localized inside the rectum, becoming an extremely rare complication. CLINICAL CASE: We report the first case of a 54-year old woman with transanal bleeding whose endoscopic investigation showed a hairy-covered tumor in its surface localized 15 cm from the anal margin. Scanning detected its exact location and the presence of bony tissue within. By means of a laparotomy, we identified the left ovary fusioned to the anterior face of the rectum where a 5 x 4 cm tumor was originally protruding towards its lumen. Left oophorectomy was performed and through a peri-tumoral section of the intestinal wall we extracted the tumor from the inner rectum and closed the defect with simple sutures. Histological report demonstrated a conglomerate of tissues that corresponded to the three germinal layers. CONCLUSIONS: Although rare, diagnosis of intrarectal ovarian teratoma must be considered as a differential diagnosis in patients with rectal tumors. Diagnosis is relatively easy in the presence of a tumor with a hairy surface that is evaluated endoscopically. For treatment we suggest a simple procedure with adequate results.

Teratoma sólido maduro de ovario con protrusión intrarrectal: informe de un caso / Solid mature ovarian teratoma with intrarectal protusion: case report

Introducción: El teratoma primario de recto es una entidad extremadamente rara; se ha sugerido que deriva de células germinales aberrantes del tracto digestivo embrionario. Una complicación inusitada es que el tumor ovárico erosione la pared rectal y permita la formación de una fístula para así alojarse en el interior del recto. Caso clínico: Mujer de 54 años de edad con sangrado transanal. Por endoscopia se observó tumor cubierto de pelos en su superficie, localizado a 15 cm del margen anal. Una tomografía computarizada identificó la localización exacta y la presencia de tejido óseo en su interior. Mediante laparotomía se apreció el ovario izquierdo fusionado a la cara anterior del recto, de donde se originaba un tumor de 5 × 4 cm que protruía hacia su luz. Se realizó ooforectomía izquierda y mediante sección peritumoral de la pared intestinal se extrajo el tumor del interior del recto y se cerró el defecto con suturas simples. El estudio histológico demostró conglomeración de tejidos correspondiente a los tres estratos germinales. Conclusiones: Aunque es raro, el diagnóstico de teratoma de ovario intrarrectal debe ser considerado en pacientes con tumores del recto. El diagnóstico es relativamente fácil ante la presencia de pelos en la superficie tumoral, que se evalúa mediante endoscopia.

BACKGROUND: Primary rectal teratoma is a very rare entity. It has been suggested that these tumors grow from aberrant germinal cells of the embryonic digestive tract. Ovarian tumor can also erode the rectal wall, allowing the formation of a fistula localized inside the rectum, becoming an extremely rare complication. CLINICAL CASE: We report the first case of a 54-year old woman with transanal bleeding whose endoscopic investigation showed a hairy-covered tumor in its surface localized 15 cm from the anal margin. Scanning detected its exact location and the presence of bony tissue within. By means of a laparotomy, we identified the left ovary fusioned to the anterior face of the rectum where a 5 x 4 cm tumor was originally protruding towards its lumen. Left oophorectomy was performed and through a peri-tumoral section of the intestinal wall we extracted the tumor from the inner rectum and closed the defect with simple sutures. Histological report demonstrated a conglomerate of tissues that corresponded to the three germinal layers. CONCLUSIONS: Although rare, diagnosis of intrarectal ovarian teratoma must be considered as a differential diagnosis in patients with rectal tumors. Diagnosis is relatively easy in the presence of a tumor with a hairy surface that is evaluated endoscopically. For treatment we suggest a simple procedure with adequate results.

[Transverse glossectomy for tongue cancer treatment]. / Glosectomía transversa para el tratamiento del cáncer de lengua.

INTRODUCTION: Standard care of patients with oral tongue-invasive squamous cell carcinoma in early stages is local resection and neck dissection. Traditionally, tumor resection was performed with hemiglossectomy (tongue resection in lingual long axis), which implied morbidity for deglutition and speech. Although surgical margins are sufficient, they are usually larger than necessary. OBJECTIVE: To know functional results and surgical margins in patients with T1-T2 oral tongue cancer submitted to transverse glossectomy (TG). MATERIAL AND METHODS: We analyzed charts of patients with T1-T2 oral tongue squamous cell carcinoma treated by TG during a 2-year period. We studied surgical margins, deglutition, speech intangibility, performance status and patient satisfaction. RESULTS: We included 20 patients: 12 women and eight men, with mean age of 45 years. Tumor-thickness mean was 8 mm; 19 patients showed free tumor margins in definitive histology study with mean of 1.8 cm three-dimensionally. In one patient, frozen sections were free-of-tumor, but definitive study showed a microscopic area of squamous cell carcinoma in surgical margin. All patients preserved > 50% of oral tongue and all showed lingual tip deviation and short tongue. None required nasogastric tube for feeding and speech was intelligible in all patients. CONCLUSIONS: TG provided sufficient surgical margin in all patients in this series without important morbidity and with good functional result; thus, TG is an alternative to classic vertical hemiglossectomy for patients in early stages of tongue mobile cancer.