Effect of Phenylalanine-Arginine Beta-Naphthylamide on the Values of Minimum Inhibitory Concentration of Quinolones and Aminoglycosides in Clinical Isolates of Acinetobacter baumannii.

(1) Background: Acinetobacter baumannii has become the most important pathogen responsible for nosocomial infections in health systems. It expresses several resistance mechanisms, including the production of ß-lactamases, changes in the cell membrane, and the expression of efflux pumps. (2) Methods: A. baumannii was detected by PCR amplification of the blaOXA-51-like gene. Antimicrobial susceptibility to fluoroquinolones and aminoglycosides was assessed using the broth microdilution technique according to 2018 CLSI guidelines. Efflux pump system activity was assessed by the addition of a phenylalanine-arginine beta-naphthylamide (PAßN) inhibitor. (3) Results: A total of nineteen A. baumannii clinical isolates were included in the study. In an overall analysis, in the presence of PAßN, amikacin susceptibility rates changed from 84.2% to 100%; regarding tobramycin, they changed from 68.4% to 84.2%; for nalidixic acid, they changed from 73.7% to 79.0%; as per ciprofloxacin, they changed from 68.4% to 73.7%; and, for levofloxacin, they stayed as 79.0% in both groups. (4) Conclusions: The addition of PAßN demonstrated a decrease in the rates of resistance to antimicrobials from the family of quinolones and aminoglycosides. Efflux pumps play an important role in the emergence of multidrug-resistant A. baumannii strains, and their inhibition may be useful as adjunctive therapy against this pathogen.

Metástasis gástrica de tumor de células germinales mixto primario testicular: reporte de caso / Gastric metastasis of primary testicular mixed germ cell tumor: A case report

RESUMEN El cáncer de testículo es el tumor sólido más común en los varones de 15 a 29 años. Puede producirse metástasis por vía hematógena o linfática a distintos órganos como pulmón e hígado (usuales) y estómago (inusual). Se presenta el caso de un varón de 30 años que cursa con hemorragia digestiva alta por dos úlceras en el cuerpo gástrico con histología de neoplasia maligna indiferenciada de células pequeñas. En las tomografías se observa tumor testicular derecho con implantes secundarios en cerebro, pulmón, hígado y bazo. Se estudia β-HCG (35 5354 mUI/ml), AFP (500 ng/mL) y DHL (1669 UI/L). Se realiza una orquiectomía radical derecha y se concluyeque es un tumor de células germinales primario de testículo derecho de estadio clínico IIIC por metástasis hepática, esplénica, pulmonar, gástrica y cerebral.

ABSTRACT Testicular cancer is the most common solid tumor in men between ages 15 and 29. It can metastasize through the hematogenous or lymphatic routes to different organs such as the lung and liver (common) and the stomach (uncommon). We present the case of a 30-year-old male patient with upper gastrointestinal bleeding due to two ulcers in the stomach body with histology of unspecified small-cell malignant neoplasm. CT scans showed a right testicular tumor with secondary implants in the brain, lung, liver and spleen. β-HCG (35,5354 mIU/mL), AFP (500 ng/mL) and LDH (1,669 IU/L) tests were conducted. A right radical orchiectomy was performed. It is concluded that this was a clinical stage IIIC primary germ cell tumor of the right testis due to liver, spleen, lung, gastric and brain metastases.

Proctitis crónica hemorrágica por radioterapia en el Instituto Nacional de Enfermedades Neoplásicas del Perú, 2011-2013 / Radiotherapy associated chronic hemorrhagic proctitis at the National Institute of Neoplastic Diseases of Peru, 2011-2013

Objetivo: Estudiar las características clínicas y endoscópicas de la proctitis crónica hemorrágica por radioterapia en el Instituto Nacional de Enfermedades Neoplásicas del Perú. Materiales y métodos: Estudio descriptivo, retrospectivo y longitudinal, con una población de 588 pacientes con esta patología, en el periodo 2011-2013, de donde se seleccionaron 114 pacientes por muestreo probabilístico aleatorizado. Se usó la estadística descriptiva e inferencial para el análisis de las variables cualitativas y cuantitativas. Resultados: La investigación encontró como principales resultados, un periodo de latencia de 439,96 días; la severidad de rectorragia clínica fue grado II y III en el 86,84%, la hemoglobina media fue de 11,63 gr/dl, los hallazgos endoscópicos fueron severidad moderada en el 58,77%, extensión solo rectal en el 92,11%, friabilidad leve del 43,86%, compromiso menor del 33% de la superficie rectal en el 71,93% y una longitud media de 7,28 cm. Los hallazgos inflamatorios fueron de cicatrices en el 0,88%, erosiones del 0,88%, de úlceras del 7%, de fístula del 0,88% y del 3,51% de estenosis rectales, el tratamiento de argón plasma coagulación (APC) único o combinado se ofreció en el 96% de los casos. Conclusiones: La proctitis crónica hemorrágica por radioterapia fue una complicación importante de la radioterapia pélvica, con hallazgos clínicos y endoscópicos característicos.

Objective: To study the clinical and endoscopic features of chronic hemorrhagic proctitis by radiotherapy in the National Institute of Neoplastic Diseases of Peru. Materials and methods: The study was descriptive, retrospective and longitudinal, with a population of 588 patients with this pathology, in the period 2011-2013, from which 114 patients were selected by randomized probabilistic sampling. Descriptive and inferential statistics were used for the analysis of qualitative and quantitative variables. Results: The main results were a latency period of 439.96 days; the severity of clinical rectal bleeding was grade 2 and 3 in 86.84%, the mean hemoglobin in chronic hemorrhagic proctitis by radiotherapy was 11.63 g / dl, the endoscopic findings were moderate severity in 58.77%, extension rectal only in 92.11%, slight friability of 43.86%, compromise less than 33% of the rectal surface in 71.93% and an average length of 7.28 cm. The inflammatory findings were 0.88% scars, erosions of 0.88%, ulcers of 7%, fistula of 0.88% and 3.51% of rectal stenosis, single or combined argon plasma coagulation (APC) treatment was offered in 96% of cases. Conclusion: Chronic hemorrhagic proctitis is an important complication of pelvic radiotherapy, with characteristic clinical and endoscopic findings.

Coriocarcinoma gástrico primario: reporte de caso / Primary gastric choriocarcinoma: a case report

El coriocarcinoma gástrico primario (CGP) es un tumor infrecuente. Debido a su rareza, su patogenia aún no es clara. El diagnóstico se basa en la inmunohistopatología, la cual es positiva para gonadotropina coriónica humana (hCG). Es una neoplasia altamente invasiva y de rápida diseminación hematógena, lo que conlleva a un pobre pronóstico. Se presenta el caso de una paciente mujer de 57 años con hemorragia digestiva alta asociada a baja de peso. La gastroscopia reporta, a nivel de cardias y región paracardial, lesión polipoidea ulcerada de 5x4 cm, con bordes circunscritos y sin presencia de infiltración de pared adyacente, con estigmas de sangrado reciente y anatomía patológica que informa neoplasia maligna pleomórfica ulcerada con inmunohistoquímica positiva para panqueratina. Ante la sospecha de carcinoma poco diferenciado y sin evidencia de metástasis, la paciente fue sometida a gastrectomía total y la patología fue compatible con coriocarcinoma. Por ello, posterior a la cirugía, se realiza estudio de hCG sérico con resultado de 714 mIU/ml, lo que confirmó aún más el diagnóstico. Se decide tratamiento adyuvante con quimioterapia y se realiza seguimiento tomográfico y serológico de hCG sin presencia de enfermedad activa.

Primary gastric choriocarcinoma (PGC) is an uncommon tumor. Due to its rarity, its pathogenesis is still unclear. The diagnosis is based on immunohistopathology, which is positive for human chorionic gonadotropin (hCG). It is a highly invasive and rapidly-disseminated hematogenous neoplasm, which leads to a poor prognosis. We present the case of a 57-year-old woman with upper gastrointestinal bleeding associated with weight loss. The gastroscopy showed, on the cardia and paracardial region, a 5x4-cm ulcerated polypoid lesion with circumscribed edges and without adjacent wall infiltration, with stigmas of recent bleeding and a pathological anatomy that demonstrates ulcerated pleomorphic malignancy with positive immunohistochemistry for pankeratin. Given the suspicion of poorly differentiated carcinoma and without evidence of metastasis, the patient underwent a total gastrectomy and the pathology was compatible with choriocarcinoma. Therefore, after the surgery, a serum hCG test was performed with a result of 714 mIU/ml, which further confirmed the diagnosis. Treatment with adjuvant chemotherapy was decided, and a tomographic and serological hCG follow-up was conducted, without the presence of active disease.

[Radiotherapy associated chronic hemorrhagic proctitis at the National Institute of Neoplastic Diseases of Peru, 2011-2013]. / Proctitis crónica hemorrágica por radioterapia en el instituto nacional de enfermedades neoplásicas del Perú, 2011-2013.

OBJECTIVE: To study the clinical and endoscopic features of chronic hemorrhagic proctitis by radiotherapy in the National Institute of Neoplastic Diseases of Peru. MATERIALS AND METHODS: The study was descriptive, retrospective and longitudinal, with a population of 588 patients with this pathology, in the period 2011-2013, from which 114 patients were selected by randomized probabilistic sampling. Descriptive and inferential statistics were used for the analysis of qualitative and quantitative variables. RESULTS: The main results were a latency period of 439.96 days; the severity of clinical rectal bleeding was grade 2 and 3 in 86.84%, the mean hemoglobin in chronic hemorrhagic proctitis by radiotherapy was 11.63 g / dl, the endoscopic findings were moderate severity in 58.77%, extension rectal only in 92.11%, slight friability of 43.86%, compromise less than 33% of the rectal surface in 71.93% and an average length of 7.28 cm. The inflammatory findings were 0.88% scars, erosions of 0.88%, ulcers of 7%, fistula of 0.88% and 3.51% of rectal stenosis, single or combined argon plasma coagulation (APC) treatment was offered in 96% of cases. CONCLUSION: Chronic hemorrhagic proctitis is an important complication of pelvic radiotherapy, with characteristic clinical and endoscopic findings.

[Primary gastric choriocarcinoma: case report]. / Coriocarcinoma gástrico primario: reporte de caso.

Primary gastric choriocarcinoma (PGC) is an extremely rare and highly invasive tumor with rapid hematogenous spread. We present the case of a 57-year-old female patient who started with hematemesis and progressive episodes of melena, weight loss and epigastralgia. It is derived from the National Institute of Neoplastic Diseases where gastroscopy and biopsy are performed. Histological analysis reported pattern suggestive of PGC; that was confirmed by immunohistochemical analysis for human chorionic gonadotrophin and fetal alpha protein. Subsequently, the patient underwent a radical D2 gastrectomy with splenic preservation and tail of the pancreas preservation. Unfortunately, her evolution was not favorable and died due to the progression of the disease.

Coriocarcinoma gástrico primario: reporte de caso / Primary gastric choriocarcinoma: case report

El coriocarcinoma gástrico primario (CGP) es un tumor extremadamente raro, altamente invasivo y de rápida diseminación hematógena. Presentamos el caso de una paciente de 57 años que inicia con cuadro de hematemesis y, progresivamente, se le suman episodios de melena, baja de peso y epigastralgia. Es derivada al Instituto Nacional de Enfermedades Neoplásicas en donde se le realizan gastroscopía y biopsia. Así, el análisis histológico reportó patrón sugestivo para CGP; el cual se confirmó al realizarle a la paciente los estudios por imágenes necesarios y llevar a cabo el análisis inmunohistoquímico para gonadotrofina coriónica humana y alfa feto proteína. Posteriormente, a la paciente se le realiza una gastrectomía radical D2 con preservación esplénica y de cola de páncreas. Lamentablemente, su evolución no fue favorable y fallece por la progresión de la enfermedad.

Primary gastric choriocarcinoma (PGC) is an extremely rare and highly invasive tumor with rapid hematogenous spread. We present the case of a 57-year-old female patient who started with hematemesis and progressive episodes of melena, weight loss and epigastralgia. It is derived from the National Institute of Neoplastic Diseases where gastroscopy and biopsy are performed. Histological analysis reported pattern suggestive of PGC; that was confirmed by immunohistochemical analysis for human chorionic gonadotrophin and fetal alpha protein. Subsequently, the patient underwent a radical D2 gastrectomy with splenic preservation and tail of the pancreas preservation. Unfortunately, her evolution was not favorable and died due to the progression of the disease.

Tumor sólido pseudopapilar de páncreas: Tumor de Frantz / Solid pseudopapillary tumor of the pancreas: Frantz´s tumor

El tumor pseudopapilar de páncreas, también conocido como tumor de Frantz, es una enfermedad muy rara en nuestro medio, comprende menos del 3 % de los tumores pancreáticos (1). Su etiología es desconocida, y su incidencia se observa en mujeres jóvenes con predominancia de la tercera década de la vida. Presentamos el caso de una mujer de 23 años que ingresa por epigastralgia urente desde hace 3 meses, además de llenura precoz. Al examen presenta dolor a la palpación profunda. Cuenta con perfil bioquímico, hepático, marcadores tumorales dentro de valores normales, la tomografía espiral multicorte (TEM) abdomino-pélvica reporta lesión neoformativa sólida quística de morfología redondeada de bordes bien definidos, la patología confirma tumor sólido pseudopapilar de páncreas. La paciente se somete a resección de tumor, con evolución favorable.

The solid pseudopapillary tumor of the pancreas, also known as Frantz's tumor, is a very rare disease in our country, comprising less than 3 % of pancreatic tumors (1). Its etiology is unknown and it is predominantly found in young women in their third decade of life. We present the case of a 23-year-old woman who was admitted due to a 3-month burning epigastralgia and early satiety. On examination, she had pain with deep palpation. Her biochemical profile, liver profile, and tumor markers were within normal values. An abdomen and pelvis multislice helical/spiral computed tomography (CT) scan showed a solid cystic neoformative lesion with rounded structure and well-defined borders. Pathology confirmed a solid pseudopapillary tumor of the pancreas. The patient underwent a tumor resection with favorable evolution.

Effectiveness of systematic alphanumeric coded endoscopy for diagnosis of gastric intraepithelial neoplasia in a low socioeconomic population.

Background and study aims: In the Western world, gastric cancer (GC) usually presents at an advanced stage, carrying a high mortality rate. Studies have reported that 14 % to 26 % of GCs are missed at endoscopy up to 3 years before diagnosis. Systematic Alphanumeric Coded Endoscopy (SACE) has been proposed to improve quality of esophagogastroduodenoscopy (EGD) by facilitating a complete examination of the upper gastrointestinal tract. This prospective cross-sectional study was designed to determine the frequency of gastric intraepithelial neoplasia (GIN) by using the SACE approach in cohort of patients from low socioeconomic level. It also used non-targeted biopsies to evaluate the frequency of premalignant conditions. Patients and methods: A total of 601 consecutive asymptomatic or dyspeptic patients were enrolled between January 2013 and November 2014 at the Huacho regional hospital in Peru. The SACE method proposed by Emura et al, which divides the stomach into 5 regions and 21 areas, was routinely used for diagnosis. Biopsy samples were obtained from any endoscopically detected focal lesion. To evaluate gastric premalignant conditions, 4 non-targeted biopsies were taken. Results: A total of 573 patients were analyzed. The mean age was 57 years, and the female:male ratio was 1.9 : 1. In all cases, complete photo-documentation of the 21 gastric areas was achieved. The overall rate of detection of GIN was 2.8 %. Low-grade displasia, high-grade dysplasia, and adenocarcinoma were found in 13 (2.3 %), 2 (0.3 %), and 1 (0.2 %) of the patients, respectively. The prevalence of at least 1 premalignant condition was 31 %, and helicobacter pylori infection was found in 57 % of patients. Conclusions: Using the SACE approach and with proper training, we have reported herein a high frequency of GIN in patients from a low socioeconomic status. Gastric cancer detection can be improved in a Western endoscopy setting when SACE, as a screening method, is performed by a trained endoscopist.

[Inherited colorectal cancer predisposition syndromes identified in the Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru;]. / Síndromes hereditarios de predisposición al cáncer colorrectal identificados en el Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Perú

BACKGROUND: Colorectal cancer (CRC) is the fourth most common cancer in the world and is classified according to their origin in sporadic CRC (~ 70%) and genetic CRC (~ 30%), this latter involves cases of familial aggregation and inherited síndromes that predispose to CRC. OBJECTIVE: To describe inherited CRC predisposition syndromes, polyposic and non-polyposic, identified in the Oncogenetics Unit at National Institute of Cancer Disease (INEN). MATERIAL AND METHODS: A descriptive observational record from the attentions of the Oncogenetics Unit at INEN during 2009 to 2013. We included patients with personal or familiar history of CRC and/or colonic polyposis who were referred for clinical assessment to the Oncogenetics Unitat INEN. RESULTS: 59.3 % were female, 40.7 % male, 69.8% under 50 years old, 60.5% had a single CRC, 23.2% had more than one CRC or CRC associated with other extracolonic neoplasia and 32.6% had a familiar history of cancer with autosomal dominant inheritance. According to the clinical genetic diagnosis, 93.1% of the included cases were inherited syndromes that predispose to CRC, with 33.8% of colonic polyposis syndromes, 23.3% of hereditary nonpolyposis CRC syndromes (HNPCC) and 36.0% of CCRHNP probable cases. CONCLUSIONS: Clinical genetic evaluation of patients with personal or familiar history of CRC and/or colonic polyposis can identify inherited colorectal cancer predisposition syndromes and provide an appropriategenetic counseling to patients and relatives at risk, establishing guidelines to follow-up and prevention strategies to prevent morbidity and mortality by cancer.

Síndromes hereditarios de predisposición al cáncer colorrectal identificados en el Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Perú / Inherited colorectal cancer predisposition syndromes identified in the Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru

Introducción: El cáncer colorrectal (CCR) es la cuarta neoplasia más frecuente en el mundo y según el origen de las alteraciones en el genoma de las células, el CCR se clasifica en esporádico (~70%) y genético (~30%), éste último involucra a los síndromes hereditarios de predisposición al CCR. Objetivo: Describir los síndromes hereditarios de predisposición al CCR, polipósicos y no polipósicos, identificados en el consultorio de Oncogenética del INEN. Material y métodos: Estudio descriptivo observacional a partir del registro de atenciones en el consultorio de Oncogenética del INEN durante el periodo 2009 al 2013. Se incluyeron a los pacientes con antecedentes personales o familiares de CCR y/o con poliposis colónica que fueron referidos para la evaluación clínica genética al consultorio de Oncogenética del INEN. Resultados: El 59,3% fueron mujeres, 40,7% varones, 69,8% fueron menores de 50 años, 60,5% presentó un CCR único, 23,2% más de un CCR o un CCR asociado a otra neoplasia extracolónica y el 32,6% poseían antecedentes familiares de cáncer con patrón de herencia autosómico dominante. Según el diagnóstico clínico genético, el 93,1% de los casos incluidos correspondieron a síndromes hereditarios de predisposición al CCR, siendo el 33,8% síndromes de poliposis colónica, 23,3% síndromes de CCR hereditario no polipósico (CCRHNP) y el 36,0% casos probables de síndrome CCRHNP. Conclusiones: La evaluación clínica genética de los pacientes con antecedentes personales o familiares de CCR y/o con poliposis colónica permite identificar a los síndromes hereditarios de predisposición al CCR y brindar una adecuada asesoría genética al paciente y familiares en riesgo, estableciendo medidas de seguimiento y estrategias de prevención a fin de evitar la morbimortalidad por cáncer.

Background: Colorectal cancer (CRC) is the fourth most common cancer in the world and is classified according to their origin in sporadic CRC (~ 70%) and genetic CRC (~ 30%), this latter involves cases of familial aggregation and inherited syndromes that predispose to CRC. Objective: To describe inherited CRC predisposition syndromes, polyposic and non-polyposic, identified in the Oncogenetics Unit at National Institute of Cancer Disease (INEN). Material and methods: A descriptive observational record from the attentions of the Oncogenetics Unit at INEN during 2009 to 2013. We included patients with personal or familiar history of CRC and/or colonic polyposis who were referred for clinical assessment to the Oncogenetics Unit at INEN. Results: 59.3 % were female, 40.7 % male, 69.8% under 50 years old, 60.5% had a single CRC, 23.2% had more than one CRC or CRC associated with other extracolonic neoplasia and 32.6% had a familiar history of cancer with autosomal dominant inheritance. According to the clinical genetic diagnosis, 93.1% of the included cases were inherited syndromes that predispose to CRC, with 33.8% of colonic polyposis syndromes, 23.3% of hereditary nonpolyposis CRC syndromes (HNPCC) and 36.0% of CCRHNP probable cases. Conclusions: Clinical genetic evaluation of patients with personal or familiar history of CRC and/or colonic polyposis can identify inherited colorectal cancer predisposition syndromes and provide an appropriate genetic counseling to patients and relatives at risk, establishing guidelines to follow-up and prevention strategies to prevent morbidity and mortality by cancer.

Factores de sobrevida en 152 pacientes con tumores estromales gastrointestinales / Survival factors in 152 patients with gastrointestinal stromal tumors

INTRODUCCIÓN: El tumor estromal gastrointestinal (GIST), es la designación para un tipo específico de tumor mesenquimal del tracto digestivo que proviene de las células intersticiales de Cajal (ICC) o de sus precursores multipotenciales, es de presentación infrecuente y por ello, su mejor conocimiento deberá incidir en un adecuado manejo diagnóstico y terapéutico. OBJETIVOS: Valorar las características clínicas e identificar los factores que influencian la sobrevida de los pacientes con diagnóstico de tumor estromal gastrointestinal. MATERIAL Y MÉTODOS: El presente estudio es de diseño cuantitativo, no experimental, descriptivo, retrospectivo y transversal. Ha sido realizado en 152 pacientes con diagnóstico de tumor estromal gastrointestinal que fueron atendidos en el Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima-Perú, desde Enero del año 1999 hasta Diciembre del año 2009. Para el diagnóstico definitivo se consignó el resultado de la pieza quirúrgica y la histología se complementó con test de inmuno histoquímica. Para valorar la distribución normal de la población se usaron las pruebas de Shapiro-Wolk, Anderson-Darling, Lilliefors, respecto a la estadística inferencial se usó tablas de supervivencia y para valorar la significancia en el análisis univariado (p<0.05 significativa), se usaronlas pruebas de Wilcoxon, Tarone-ware y Log-rank, además para evaluar la diferencia entre grupos en las tablas de contingencia se utilizó el chi cuadrado y el test de Fisher. El análisis multivariado se realizó utilizando el modelo de riesgo proporcional de Cox.RESULTADOS: El grupo de 152 pacientes comprendió 78 mujeres (51%) y 74 varones (49%) con rango etáreo de 16 a 92 años, con una edad promedio de 54 años. La frecuencia de presentación se incrementó a partir de la cuarta década de vida y alcanzó su mayor expresión entre los 50 y 70 años. La presentación inicial fue de enfermedad localizada para 79 pacientes (52%) y con metástasis primaria...

INTRODUCTION: The gastrointestinal stromal tumor (GIST) is the designation for a specific type of mesenchymal tumor of the digestive tract that is origin in the interstitial cells of Cajal (ICC) or its precursor multipotentials, its presentation is rare and therefore its best knowledge must affect a proper diagnosis and treatment. OBJECTIVES: To evaluate the clinical characteristics and to identify factors influencing survival of patients with gastrointestinal stromal tumor. MATERIAL AND METHODS: This study design is quantitative, non experimental, descriptive, retrospective and transversal. The study has been performed in 152 patients with gastrointestinal stromal tumor who were treated at the National Institute of Neoplastic Diseases (INEN), Lima, Peru, from January 1999 through December 2009. For the final diagnosis was registered the outcome of the surgical and histology was complemented by immunohistochemical test. To assess the normal distribution of the population was used the Shapiro-Wolk, Anderson-Darling, Lilliefors, regarding the use of inferential statistical tables for survival and to assess its significance in the univariate analysis (p<0.05 significance), was used the Wilcoxon test, Tarone-Ware Log-rank and also to evaluate the difference between groups in contingency tables used the chi square and FisherÆs test. Multivariate analysis was performed using the proportional hazards model of Cox. RESULTS: The group of 152 patients included 78 women (51%) and 74 men (49%) with age range from 16 to 92 years, with an average age of 54. The frequency presentation was increased from the fourth decade of life and reaches its highest expression between 50 and 70. The initial presentation was with localized disease to 79 patients (52%) and primary metastases in 73 patients (48%), with an average time of disease 14 months. The prevalence of GIST tumor in the differents organs was as follows: stomach with 77 patients (50.65%), jejunum with 21 patients...

[Case reports. Endoscopic resection of rectal carcinoid tumors: classical and submucosal resection with band-snare method]. / Resección Endoscópica de Tumor Carcinoide RectaL: Extracción Clásica y con Elevación Submucosa y Banda.

Rectal isolated carcinoid tumor can de treated endoscopically and locally. There is concern about margin involvement due to the fact that there is inward migration of these lessions from the mucosa into deeper layers (submucosa), because of the internal origin in Kutchinsky cells, which are located between mucosa and submucosa (deep in the mucosa). We review and present 6 cases of rectal carcinoid tumors treated endoscopically with polypectomy, polypectomy plus sub mucosal elevation and band -snare-elevation resection. We review current techniques, benefits of elevation, and results from the Endoscopy Unit at the INEN or National Cancer Center (Instituto Nacional de Enfermedades Neoplásicas) in Lima-Perú.

Resección endoscópica de tumor carcinoide rectal: extracción clásica y con elevación submucosa y banda / Endoscopic resection of rectal carcinoid tumors: clasical and submucosal resection with band-snare method

El tumor carcinoide rectal aislado, puede ser resecado localmente. Existe preocupación sobre compromiso de los márgenes al ser estas lesiones mucosas pero con crecimiento hacia la sub-mucosa, al originarse en las células enterocromafines de Kutchinsky que limitan con esta última. Presentamos una serie de 6 casos de tumor carcinoide rectal tratados endoscópicamente con polipectomía, polipectomía con elevación y aplicación de banda elástica. Se revisa la tecnología actual, los beneficios de la elevación y los resultados de la técnica en el área de endoscopia del servicio de gastroenterología del Instituto Nacional de Enfermedades Neoplásicas (INEN).

concern about margin involvement due to the fact that there is inward migration of these lessions from the mucosa into deeper layers (submucosa), because of the internal origin in Kutchinsky cells, which are located between mucosa and submucosa (deep in the mucosa). We review and present 6 cases of rectal carcinoid tumors treated endoscopically with polypectomy, polypectomy plus sub mucosal elevation and band ûsnare-elevation resection. We review current techniques, benefits of elevation, and results from the Endoscopy Unit at the INEN or National Cancer Center (Instituto Nacional de Enfermedades Neoplásicas) in Lima-Perú.

[Survival factors in 152 patients with gastrointestinal stromal tumors]. / Factores de sobrevida en 152 pacientes con tumores estromales gastrointestinales.

INTRODUCTION: The gastrointestinal stromal tumor (GIST) is the designation for a specific type of mesenchymal tumor of the digestive tract that is origin in the interstitial cells of Cajal (ICC) or its precursor multipotentials, its presentation is rare and therefore its best knowledge must affect a proper diagnosis and treatment. OBJECTIVES: To evaluate the clinical characteristics and to identify factors influencing survival of patients with gastrointestinal stromal tumor. MATERIAL AND METHODS: This study design is quantitative, non experimental, descriptive, retrospective and transversal. The study has been performed in 152 patients with gastrointestinal stromal tumor who were treated at the National Institute of Neoplastic Diseases (INEN), Lima, Peru, from January 1999 through December 2009. For the final diagnosis was registered the outcome of the surgical and histology was complemented by immunohistochemical test. To assess the normal distribution of the population was used the Shapiro-Wolk, Anderson-Darling, Lilliefors, regarding the use of inferential statistical tables for survival and to assess its significance in the univariate analysis (p <0.05 significance), was used the Wilcoxon test, Tarone-Ware Log-rank and also to evaluate the difference between groups in contingency tables used the chi square and Fisher's test. Multivariate analysis was performed using the proportional hazards model of Cox. RESULTS: The group of 152 patients included 78 women (51%) and 74 men (49%) with age range from 16 to 92 years, with an average age of 54. The frequency presentation was increased from the fourth decade of life and reaches its highest expression between 50 and 70. The initial presentation was with localized disease to 79 patients (52%) and primary metastases in 73 patients (48%), with an average time of disease 14 months. The prevalence of GIST tumor in the different organs was as follows: stomach with 77 patients (50.65%), jejunum with 21 patients (13.82%), retroperitoneum with 17 patients (11.18%), duodenum 11 patients (7.24%), colon 11 patients (7.24%), ileum 8 patients (5.26%),pancreas, 3 patients (1.97%), rectum, 3 patients (1.97%) and esophagus with 1 patient (0.66%). The most common symptoms of GIST tumors in general were gastrointestinal bleeding, abdominal tumor and abdominal pain. There are organ-specific symptoms such as jaundice in pancreas, dysphagia in esophagus and obstruction in the ileum. The tumor size greater than 10 centimeters was found in 92 patients (60.51%), 39 patients had size between 5 and 10 centimeters (25.65%) and 20 patients had lesions smaller than 5 centimeters (13.15%). Immunohistochemistry tests performed in 75 patients show that for all locations, the expression of KIT (CD117) is 94.8%, followed by CD34 to 70.35%; on the other hand, actin (61.68%) and S-100 (57.56%) have a smaller range of expression. Retroperitoneal GIST tumors had an expression of CD117 of 92.86% and CD34 of 60%, and GIST tumors of the pancreas had an expression of CD117 of 100% and CD34 of 100%. We evaluated 27 patients with low mitotic index, of which 10 had primary metastases (37%), in turn, of 25 patients with high mitotic index, 8 had primary metastases (32%). Of the 152 patients, 93 had complete resection of the disease, 28 had partial resection, 24 were unresectable and 07 did not undergo surgery, the more aggressive behavior was observed in ileum, 03 patients were unresectable, 02 patients had partial resection and only 02 could be completely resected, the rest of the series in general, for each location, the GIST tumors completely resected outscored the unresectable and partially resected. Of 93 patients that had completely resected, recurrence was found in 32 of these patients (34.4%), recurrence was local in 8 patients, metastases in 18 patients and local recurrence + metastases in 6 patients, with an average time of recurrence 22 months. The overall cumulative survival at 5 years was 81.35%. The survival of patients under and over 50 expressed a p = 0.08, cumulative survival rates by tumor size expressed p = 0.56, cumulative survival rates for stomach and intestinal location shows a p = 0.056. The 5-year survival of completely resected patients was 87.70%. Overall survival of patients with and without metastasis expressed p = 0.001, the cumulative survival function completely resected patients, the resected and partially resected, expresses with p <0.0001. Multivariate analysis showed that the most significant factor for disease progression was the primary metastases with p = 0.007, and that survival was directly related to complete resection of the disease which is expressed with p <0.0001. CONCLUSIONS: The most important prognostic factor of survival for gastrointestinal stromal tumors (GIST) is the complete resection of the disease. The factor that is associated with progression of the disease is the presence of metastases. In our series of 152 patients, tumor locations tend to relate better survival in gastric GIST that in intestinal GIST. Similarly, we found a tendency to express a lower survival in patients younger than 50 years. Differentiated tumor size in three size categories expressed no more related to survival. The low mitotic index associated with metastasis, not reflected a good prognosis of disease.

[Pancreatic adenocarcinoma in young patient diagnosed by endoscopic ultrasonography]. / Adenocarcinoma de páncreas en paciente joven diagnosticado por ultrasonografía endoscópica.

The Pancreatic adenocarcinoma appears generally in patients with more than 60 years old. Their finding in young people is very rare. We report the case of a man of 29 years diagnosed and treated in the National Institute of Neoplastic Diseases (INEN), that presented symptoms as: dorsalgia, jaundice and weight loss. The tomografic image showed a mass located in the head of the pancreas with hepatic and ganglionar metastases. It was evaluated by means of endoscopic ultrasonography (USE) and performed a directed fine needle puncture aspiration (PAAF), that obtained a bad differentiated adenocarcinoma from the pancreas. An endoscopic biliary drainage by PCRE was realized later and treatment with chemotherapy started. We present the case by the unusual occurrence in the related age group and by the importance of the puncture guided by endoscopic ultrasonography in the diagnosis and handling of this pathology [corrected]

Adenocarcinoma de Páncreas en paciente joven diagnosticado por Ultrasonografía Endoscópica / Adenocarcinoma of the pancreas in young patients diagnosed by endoscopic ultrasonography

El adenocarcinoma de páncreas se presenta por lo general en pacientes mayores de 60 años. El hallazgo en gente joven es muy raro. Reportamos el caso de un varón de 29 años diagnosticado y tratado en el Instituto Nacional de Enfermedades Neoplásicas(INEN), quien presentó como síntomas principales: dorsalgia, ictericia y baja ponderal. La imagen tomográfica mostró una masa ubicada en la cabeza del páncreas asociada a metástasis hepática y ganglionar múltiples. Fue evaluado mediante ultrasonografía endoscópica (USE), realizándose una punción aspiración dirigida con aguja fina (PAAF), para la obtención de muestra correspondiendo a un adenocarcinoma poco diferenciado de páncreas. Se realizó un drenaje biliar endoscópico por PCRE y posteriormente tratamiento con quimioterapia. Se presenta el caso por lo infrecuente de su manifestación en el grupo etáreo señalado y por la importancia de la punción guiada por ultrasonografía endoscópica en el diagnóstico y manejo de dicha patología.

Diffuse hemangioma of the rectum is a rare benign vascular lesion. The case of a 30 year-oldmale with intermittent rectal bleeding with an evolution of 2 years and symptoms relatedto chronic ferropenic anemia is presented. The rectal endoscopy was interpreted as amalignant neoplastic epithelial lesion spread throughout the rectum. The biopsy indicatedthat it was a rectal hemangioma. A surgical resection was successfully performed. Thestudy of the surgical specimen concluded that it was a diffuse rectal hemangioma.