Liver metastases of colorectal adenocarcinoma with intrahepatic biliary spread pattern: clinical manifestation and importance of immunohistochemical analysis.

Liver metastases of colorectal carcinoma (LMCC) with macroscopic intrabiliary ductal involvement are a rare entity that can clinically and radiologically mimic a cholangiocarcinoma. However, a thorough anatomopathologic and immunohistochemical study of biliary ductal involvement is required because of its distinctive clinical features and relatively indolent biological behavior, reflecting a better prognosis and long-term survival. We present the case of a patient who debuted with LMCC with intrahepatic biliary ductal involvement, whose definitive diagnosis was established by immunohistochemical analysis, showing a characteristic CK7 - /CK20 + pattern.

Upper Gastrointestinal Bleeding as a Debut Form of Groove Pancreatitis: A Diagnostic Challenge.

Introduction: Groove pancreatitis (GP) is an unusual subtype of chronic pancreatitis that affects the groove area. Differential diagnosis between groove pancreatitis and pancreatic carcinoma (PC) can be challenging, both clinically and radiologically. Our aim is to report the first case of GP debut with upper gastrointestinal bleeding (UGB). Case Report. A 53-year-old man with a personal history of alcohol and tobacco abuse and chronic pancreatitis was admitted to the hospital for epigastric abdominal pain. A computed tomography scan showed a locally advanced neoformative lesion in the distal stomach. The patient presented melena, arterial hypotension, and 4.4 g/dl of hemoglobin. An upper gastrointestinal endoscopy showed a neoformative ulcerated lesion at the duodenal bulb without active bleeding. Biopsies were taken, and histopathological analysis did not show malignancy. A cephalic pancreaticoduodenectomy was performed, and the postoperative period was uneventful. Histopathological analysis revealed a segmental GP. Discussion. GP is an uncommon entity, and its clinical and radiological presentation mimics PC. However, with advances in imaging tests, several radiological criteria have been described to distinguish GP from PC preoperatively. Although some authors recommend a stepwise management with initial conservative therapy, a therapeutic strategy has not yet been established. Conclusion: GP is an uncommon type of focal pancreatitis that should be considered as a differential diagnosis of PC. We report the first clinical case of GP whose debut with UGB presented a greater diagnostic and therapeutic challenge.

[Síndrome de compresión del ligamento arcuato medio en el adulto: a propósito de dos casos]. / Median arcuate ligament syndrome in adults with laparoscopic treatment: report of two cases.

The medium arcuate ligament syndrome is a rare disorder that results from luminal narrowing of the celiac artery by the insertion of diaphragmatic muscle or the celiac nerve plexus. The syndrome is characterized by weight loss, postprandial abdominal pain, nausea, vomiting and an epigastric murmur. Surgical management involves the complete division of the medial arcuate ligament. We present two cases satisfactorily treated by laparoscopic surgery. The role of minimally invasive surgery in the treatment of this syndrome is a safe alternative approach to open surgery.

El síndrome de ligamento arcuato medio es un trastorno poco frecuente que resulta del estrechamiento luminal de la arteria celíaca por la inserción de fibras musculares diafragmáticas o bandas fibrosas del plexo nervioso celíaco. El síndrome se caracteriza por pérdida de peso, dolor abdominal posprandial, náuseas, vómitos y un soplo epigástrico. El manejo quirúrgico implica la división completa del ligamento arqueado mediano. Presentamos dos casos tratados satisfactoriamente mediante cirugía laparoscópica. El papel de la cirugía mínimamente invasiva en el tratamiento de este síndrome es una vía de abordaje segura alternativa a la cirugía abierta.

[Moderately differentiated adenocarcinoma of the third duodenal portion]. / Adenocarcinoma de la tercera porción duodenal moderadamente diferenciado.

BACKGROUND: Duodenal carcinoma is very rare. It represents 33-45% of the all tumours of the small bowel. The symptoms are non-specific, and the diagnosis is often accidental. CLINICAL CASE: A 35-year old man was admitted to our hospital with post-prandial abdominal pain. Upper gastrointestinal examination revealed a tumour of the third duodenal portion, which was diagnosed, using endoscopic biopsy, as a tubular adenoma with high grade dysplasia. The computed axial tomography scan, the magnetic resonance imaging, and the endoscopic ultrasound showed the neoplasia of the third duodenal portion with no lymph node or peritoneal metastases. Partial resection of the duodenum was performed. The definitive histopathological diagnosis was primary adenocarcinoma of the third duodenal portion. pT2 N0M0, originated in a tubular adenoma. CONCLUSIONS: Primitive neoplasia of the duodenum is very rare. Duodeno-cephalo-pancreatectomy is recommended in proximally located tumours, while segmental resection of the duodenum is appropriate for distal locations, with the same survival.

Síndrome del ducto pancreático desconectado / Disconnected pancreatic duct syndrome

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Neoplasia sólida pseudopapilar de páncreas / Solid pseudopapillary neoplasm of the pancreas

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Cistoadenocarcinoma mucinoso retroperitoneal primario / Primary retroperitoneal mucinous cystadenocarcinoma

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