Leiomiosarcoma intratesticular primario diagnosticado por biopsia hepática percutánea ecodirigida / Intratesticular Leiomyosarcoma Diagnosed by Percutaneous Liver Biopsy

Se presenta el caso clínico de un varón de 80 años diagnosticado de leiomiosarcoma testicular primario, a raíz de alteraciones del perfil hepático en analítica sanguínea y lesiones ocupantes de espacio (LOE) hepatoesplénicas en ecografía abdominal. En primer lugar, se realizó punción de lesión hepática y posteriormente orquiectomía radical, revelando concordancia histológica, compatible con leiomiosarcoma intratesticular. Presentamos el caso clínico debido a la rareza de ese tipo de tumores, sobre todo en estadio III, y su peculiar diagnóstico, tras la detección de alteración hepática tanto analítica como ecográfica

We present a case of an 80-year-old male diagnosed with primary testicular leiomyosarcoma due to the detection of hepatic profile analytical alterations and hepatosplenic space-occupying lesions in abdominal ultrasound. Puncture of hepatic lesion was performed first and radical orchiectomy later, revealing histological concordance, compatible with intratesticular leiomyosarcoma. We present the case due to the uncommon of this type of tumors, especially in stage III and its peculiar diagnosis, secondary of hepatic alteration, both analytic and ultrasound.

Cost-effectiveness of inguinal hernia surgery in northwestern Ecuador.

BACKGROUND: Cost-effectiveness of tension-free inguinal hernia repair at a private 20-bed rural hospital in Esmeraldas Province, Ecuador, was calculated relative to no treatment. METHODS: Lichtenstein repair using mosquito net or polypropylene commercial mesh was provided to patients with inguinal hernia by surgeons from Europe and North America. Prospective data were collected from provider, patient, and societal perspectives, with component costs collected on site and from local supply companies or published literature. Patient outcomes were forecasted using disability adjusted life years (DALYs) averted. Uncertainty in patient-level data was evaluated with Monte-Carlo simulation. RESULTS: Surgery was provided to 102 patients with inguinal hernias of various sizes. Local anesthesia was used for 80 % of operations during the first mission, and spinal anesthesia was used for 89 % in the second mission. Few complications were observed. An average 6.39 DALYs (3,0) were averted per patient (95 % confidence interval: 6.22-6.84). The average cost per patient was US$499.33 (95 % CI: US$490.19-$526.03) from a provider perspective, US$118.79 (95 % CI: US$110.28-$143.72) from a patient perspective, and US$615.46 (95 % CI: US$603.39-$650.40) from a societal perspective. Mean cost-effectiveness from a provider perspective was US$78.18/DALY averted (95 % CI: US$75.86-$85.78) according to DALYs (3,0) averted using the West Life Table level 26, well below the Ecuadorian per-capita Gross National Income (US$3,850). Results were robust to all sensitivity analyses. CONCLUSIONS: Inguinal hernia repair was cost-effective in western Ecuador through international collaboration.

[Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome. Contribution of two new cases]. / Síndrome "overlap" hepatitis autoinmune-cirrosis biliar primaria. Aportación de dos nuevos casos.

The autoimmune hepatitis (AIH)-primary biliary cirrhosis (PBC) overlap syndrome is characterized for clinical, biochemical, immunological, and histological features overlapping those of AIH and PBC, whose pathogenesis and more appropriate treatment are unknown at present. We describe two new patients of this entity, which made debut with cholestasic acute hepatitis accompanied of hypergammaglobulinemia. In the first patient was demonstrated the presence of AMA, ASMA, and anti-LKM1 autoantibodies; and ANA in the second one. The histological findings showed changes suggestive of AIH and PBC. After the start of immunosuppressive treatment, associated to ursodeoxycholic acid in one patient, a successful outcome was observed.

Síndrome “overlap” hepatitis autoinmune-cirrosis biliar primaria. Aportación de dos nuevos casos / Primary biliary cirrhosis-autoimmune hepatitis over lap syndrome. Contribution of two new cases

El síndrome “overlap” hepatitis autoinmune (HAI)-cirrosis biliar primaria (CBP) se caracteriza por un solapamiento de hallazgos clínicos, analíticos, inmunológicos e histológicos tanto de HAI como de CBP, cuya patogenia y tratamiento más adecuado se desconoce en la actualidad. Describimos dos nuevos casos de esta entidad, que debutaron con un brote de hepatitis aguda colestásica acompañado de hipergammaglobulinemia. En el primer caso se demostró la presencia de los anticuerpos AMA, ASMA y anti-LKM1; y en el segundo de los ANA. Los hallazgos histológicos mostraron alteraciones sugestivas de HAI y de CBP. Tras la instauración de tratamiento inmunosupresor, asociado a ácido ursodesoxicólico en un caso, se observó una buena evolución clínica

The autoimmune hepatitis (AIH)-primary biliary cirrhosis (PBC) overlap syndrome is characterized for clinical, biochemical, immunological, and histological features overlapping those of AIH and PBC, whose pathogenesis and more appropriate treatment are unknown at present. We describe two new patients of this entity, which made debut with cholestasic acute hepatitis accompanied of hypergammaglobulinemia. In the first patient was demonstrated the presence of AMA, ASMA, and anti-LKM1 autoantibodies; and ANA in the second one. The histological findings showed changes suggestive of AIH and PBC. After the start of immunosuppressive treatment, associated to ursodeoxycholic acid in one patient, a successfull outcome was observed

Leiomioma vesical / Vesical leiomyoma

OBJETIVOS: Los tumores benignos mesenquimatosos de la vejiga son tumores poco frecuentes y representan entre el 1 por ciento-5 por ciento de todos los tumores de vejiga. El leiomioma es el más común de todos ellos, con una incidencia del 46,6 por ciento dentro de ese grupo. Hasta la actualidad, en la literatura nacional han sido descritos 25 casos. CASO CLÍNICO: Varón de 53 años de edad con sintomatología miccional irritativa crónica y micro-hematuria. La exploración física era normal. La urografía intravenosa demostraba un defecto de repleción en cara lateral derecha de vejiga. La cistoscopia confirmaba el tumor, recubierto por mucosa vesical normal. La ecografía presentaba una tumoración sólida. La tomografía axial computarizada y la resonancia magnética presentaban una lesión sesil en cara lateral derecha de vejiga con baja-inter-media señal de intensidad y señal normal del músculo, mucosa y grasa perivesical. El diagnóstico clínico fue leiomioma vesical. Se practicó cistectomía parcial y el diagnóstico histológico confirmó la impresión clínica. CONCLUSIONES: El leiomioma de vejiga es un tumor poco frecuente y debe tenerse en cuenta en los diagnósticos diferenciales, antes del tratamiento quirúrgico (AU)

[Bladder leiomyoma]. / Leiomioma vesical.

OBJECTIVE: Mesenchymal benign tumours of the urinary bladder are rare and account for 1%-5% of all bladder tumours. The leiomyoma is the most common and constitute 46.6% of this group. 25 cases have been described in the national literature. We report an additional case of leiomyoma of the bladder. CASE REPORT: A 53 year-old man with a chronic history of urinary frequency and microscopic hematuria. Physical examination was normal. An excretory urography demonstrated a filling defect in the right bladder wall. The cystoscopy confirmed the tumour, covered with normal bladder mucosa. The echography showed a solid tumour. A computerised tomography scan and magnetic resonance showed a sessile lesion in the right bladder wall with low-intermediate intensity signal and with normal signal of muscle, mucosa and perivesical fat. The clinical diagnosis was leiomyoma of the bladder. Partial cystectomy was done and the histological diagnosis confirmed the clinical diagnosis. CONCLUSIONS: The leiomyoma of the bladder is a rare tumour however it should be considered in the differential diagnosis before surgical treatment.

Cytodiagnosis of gastric ulcer penetration of the liver by examination of endoscopic brushings.

The penetration of a gastric peptic ulcer into the liver was initially diagnosed by the cytologic examination of endoscopic brushings and later confirmed by an endoscopic biopsy of the stomach. One of the smears of the gastric brushing contained sparse groups of liver cells with mild atypia. The endoscopic biopsy specimen included liver parenchyma with signs of peptic hepatitis. The differential diagnostic considerations for a gastric brushing containing hepatoid cells are discussed.

Cholestatic features in focal nodular hyperplasia of the liver.

Twenty specimens of focal nodular hyperplasia were studied with special attention to the histological features of chronic cholestasis (grouped under the headings of cholestasis, cholate-stasis and signs of ductular reabsorption). In all specimens, evidence was found for one or more features of cholestasis and cholate-stasis. Signs of ductular reabsorption were less constant, and apparently varied according to the developmental stage of the lesion. The cholestatic features emphasize the bile secretory capacity of the lesional parenchyma, and are apparently due to the lack of real bile ducts in the portal tract equivalents of the lesional tissue. Evidence is presented that the "ductular component" in FNH is not due to proliferation of pre-existing ductules, but rather derives from ductular metaplasia of liver cell plates in zone 1 equivalents. This metaplastic development of a ductular network may serve the function of reabsorbing the biliary constituents produced by the lesional parenchyma, leading to periductular inflammation and progressive fibrosis, thus producing an equivalent of biliary fibrosis and biliary cirrhosis.