Reporte de un caso de quilotórax tuberculoso / A case report of tuberculous chylothorax

El quilotórax tuberculoso es una patología infecciosa infrecuente, que se produce como consecuencia del bloqueo del conducto torácico. Su tratamiento está dirigido a combatir la infección tuberculosa. Se presenta el caso de un varón de 55 años de edad, chofer, natural de Trujillo-Perú, que acudió a emergencia por disnea progresiva y tos seca de cinco días de evolución. El examen físico reveló frémito vocal, matidez y murmullo vesicular disminuido en 2/3 inferiores del hemitórax izquierdo. La radiografía y ecografía torácica evidenciaron derrame pleural significativo, y la toracocentesis reveló quilotórax. Posteriormente, se colocó un tubo de drenaje torácico, con disminución progresiva del volumen del líquido pleural y cambios citoquímicos. Se realizó videobroncoscopía diagnóstica con aspirado broncoalveolar, revelando bacilos ácido-alcohol resistentes. El paciente recibió tratamiento antituberculoso, con evolución favorable. El quilotórax tuberculoso constituye una causa importante de quilotórax a considerar en zonas endémicas de tuberculosis. El tratamiento adecuado de la infección, conlleva a resolución de la enfermedad.

Tuberculous chylothorax is a rare infectious disease that occurs when the thoracic duct is obstructed. Treatment is directed to the tuberculosis infection. A 55-year-old male, driver, born in Trujillo (Peru) is admitted to the emergency department with increasing dyspnea and a 5-day dry cough. The physical examination revealed vocal fremitus, dullness to percussion, and a vesicular murmur that was decreased on the lower 2/3 of the left hemithorax. The X-ray and the thoracic ultrasound revealed significant left pleural effusion. The thoracocentesis drained fluid identified as chylothorax. Subsequently, a thoracic tube was placed, with a decrease in pleural fluid volume and later normalization of the cytochemical changes. Diagnostic video bronchoscopy was performed with a bronchoalveolar aspirate, revealing acid-fast bacilli. The patient received antituberculosis treatment with a favorable outcome. Tuberculous chylothorax is an important cause of chylothorax to be considered in endemic areas of tuberculosis. Proper treatment of the infection leads to resolution of the disease.

Sentinel lymph node biopsy as a prognostic factor in non-metastatic colon cancer: a prospective study

Purpose. Around a third of node-negative patients with colon cancer experience a recurrence after surgery, suggesting poor staging. Sentinel lymph node techniques combined with immunochemistry could improve colon cancer staging. We prospectively assessed the effect of Sentinel node mapping on staging and survival in patients with non-metastatic colon cancer. Methods. An observational and prospective study was designed. 105 patients with colon cancer were selected. Patients were classified according to node involvement as: N1, with node invasion detected by the conventional techniques; up-staged, with node invasion detected only by sentinel node mapping; and N0, with negative lymph node involvement by both techniques. Five-year survival and disease-free survival rates were analysed. Multivariate regression analyses were performed to identify prognostic factors for disease-free and overall survival. Results. Sentinel node mapping was successfully applied in 78 patients: 33 % were N1; 24.5 % were up-staged (18 patients with isolated tumour cells and 1 patient with micrometastases); and 42.5 % were N0. N1 patients had the poorest overall 5-year survival (65.4 %) and 5-year disease-free survival (69.2 %) rates compared with the other two groups. No significant 5-year survival differences were observed between N0 patients (87.9 %) and up-staged patients (84.2 %). Conclusions. Patients up-staged after sentinel node mapping do not have a poorer prognosis than patients without node involvement. Detection of isolated cancer cells was not a poor prognosis factor in these patients (AU)

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Sentinel lymph node biopsy as a prognostic factor in non-metastatic colon cancer: a prospective study.

PURPOSE: Around a third of node-negative patients with colon cancer experience a recurrence after surgery, suggesting poor staging. Sentinel lymph node techniques combined with immunochemistry could improve colon cancer staging. We prospectively assessed the effect of Sentinel node mapping on staging and survival in patients with non-metastatic colon cancer. METHODS: An observational and prospective study was designed. 105 patients with colon cancer were selected. Patients were classified according to node involvement as: N1, with node invasion detected by the conventional techniques; up-staged, with node invasion detected only by sentinel node mapping; and N0, with negative lymph node involvement by both techniques. Five-year survival and disease-free survival rates were analysed. Multivariate regression analyses were performed to identify prognostic factors for disease-free and overall survival. RESULTS: Sentinel node mapping was successfully applied in 78 patients: 33 % were N1; 24.5 % were up-staged (18 patients with isolated tumour cells and 1 patient with micrometastases); and 42.5 % were N0. N1 patients had the poorest overall 5-year survival (65.4 %) and 5-year disease-free survival (69.2 %) rates compared with the other two groups. No significant 5-year survival differences were observed between N0 patients (87.9 %) and up-staged patients (84.2 %). CONCLUSIONS: Patients up-staged after sentinel node mapping do not have a poorer prognosis than patients without node involvement. Detection of isolated cancer cells was not a poor prognosis factor in these patients.

Melanoma maligno primario de colon / Malignant melanoma of primary origin

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Adenocarcinoma de vesícula biliar: estadio tumoral, factores pronósticos histológicos y supervivencia / Gallbladder adenocarcinoma: tumoral staging, histological prognostic factors and survival

Introducción. El adenocarcinoma de vesícula biliar, debido a su comportamiento biológico sumamente agresivo, es uno de los tumores digestivos de peor pronóstico. En muchas ocasiones, debido a la afección locorregional y al retardo del diagnóstico, la resecabilidad con intención curativa es imposible. Presentamos, desde el punto de vista histopatológico, un estudio retrospectivo de los adenocarcinomas de vesícula biliar diagnosticados en nuestra área de influencia y evaluamos, según el estadio tumoral, los factores pronósticos histológicos y la supervivencia. Pacientes y método. Se considera a un total de 62 casos de adenocarcinoma de vesícula biliar en un período de 15 años. Realizamos la colecistectomía por vía laparoscópica, por laparotomía o tratamiento paliativo en los casos irresecables. Se comparan para cada estadio tumoral la edad, el sexo, el grado de diferenciación celular, el tamaño tumoral, la presencia de adenopatías metastásicas, los factores de mal pronóstico histológico y la supervivencia. Resultados. Predomina el número de mujeres respecto al de varones (45/17). La edad media del grupo es de 75 años. No hallamos diferencias significativas respecto a la edad y el sexo entre los diferentes grupos. El grado de diferenciación celular y la supervivencia van empeorando a medida que progresa el estadio tumoral. Hay un predominio significativo de los factores de mal pronóstico histológico en los estadios T2 y T3. Conclusiones. Es difícil diagnosticar el adenocarcinoma de la vesícula biliar de forma preoperatoria, excepto en los casos avanzados. Suelen ser hallazgos incidentales en el estudio histológico postoperatorio, localmente poco avanzados y con buen grado de diferenciación celular. La etiología es desconocida, aunque con un gran predominio en las mujeres. La clínica se superpone a la patología de la vesícula habitada. En nuestro estudio, la edad y el sexo no se relacionan con el estadio tumoral. En estadios tumorales avanzados predomina la mala diferenciación celular, junto con factores de mal pronóstico histológico. Se describe una alta supervivencia para los tumores en estadio T3, posiblemente por la buena diferenciación celular. No hemos reintervenido a ningún paciente, dada la elevada comorbilidad asociada (AU)

Introduction. Gallbladder adenocarcinoma is an aggressive tumor and is one of the digestive tract malignancies with the poorest prognosis. Because of loco-regional extension and delayed diagnosis, curative resection is often impossible. To determine histological prognostic factors and survival in relation to tumoral stage at diagnosis, we performed a retrospective study of our patients with gallbladder carcinoma. Patients and method. Sixty-two patients with gallbladder adenocarcinoma diagnosed over a 15-year period were retrospectively included in this study. The surgical procedures performed in this group of patients were laparoscopic cholecystectomy, open cholecystectomy and palliative surgery in patients with unresectable tumors. For each tumoral stage, age, sex, cellular differentiation, tumor size, the presence of metastatic nodes, histological variables linked to poor prognosis, and survival were compared. Results. Of the 62 patients included, 45 were women and 17 were men. The mean age was 75 years. No significant differences were found in relation to age or sex among the different tumoral stages. Cellular differentiation and survival were poorer with advanced tumoral stage. A significant predominance of histological factors of poor prognosis was found in T2 and T3 tumors. Conclusions. Preoperative diagnosis of gallbladder adenocarcinoma is difficult except in advanced cases. It is often incidentally diagnosed at histological examination of gallbladders, and shows little local advancement and a good degree of cellular differentiation. The etiology of this tumor is unknown but its prevalence is greater among women. Clinical symptoms are similar to those caused by gallstones. In this study no relationship was found between age and sex and tumoral stage. In advanced tumoral stages poor cellular differentiation is predominant as well as other histological markers of poor prognosis. Good survival was found in T3 tumors, possibly linked to good cellular differentiation. Due to high associated comorbidity, none of the patients underwent reintervention (AU)

Endometriomas de pared abdominal: aspectos diagnósticos / Abdominal wall endometriomas: diagnostic features

Introducción. Los endometriomas de pared abdominal suelen presentarse como masas dolorosas localizadas en las cicatrices de intervenciones ginecológicas u obstétricas, aunque se han descrito casos esporádicos de localización umbilical e inguinal. El objetivo del presente trabajo es determinar las características diagnósticas de una serie de endometriomas de pared abdominal. Pacientes y método. En el período de tiempo comprendido entre los años 1990 a 1998 se diagnosticaron en nuestro servicio 12 casos de endometriomas de pared abdominal. Se consideran para el estudio la edad de las pacientes, los antecedentes ginecológicos, la localización del foco endometriósico, la sintomatología, el tiempo de evolución y el diagnóstico preoperatorio. Resultados. La edad media de las pacientes fue de 31,3 años (rango 19-45). El endometrioma se localizó preferentemente en cicatrices de cesárea (10 casos) y en 5 casos se acompañaba de dolor relacionado con el ciclo menstrual. El tiempo de evolución de la sintomatología fue sumamente variable, oscilando entre 3 días y 3 años. El diagnóstico preoperatorio correcto se realizó en 5 pacientes, en tanto que en el resto se diagnosticaron 4 granulomas de herida, 2 hernias incarceradas y una onfalitis. Conclusiones. La presencia de un nódulo cicatrizal en una mujer fértil con antecedente de intervención ginecológica u obstétrica obliga a considerar el diagnóstico de endometrioma. Una anamnesis convenientemente dirigida es de suma utilidad para realizar el diagnóstico diferencial (masa dolorosa en relación con el ciclo menstrual), y en casos de duda puede recurrirse al estudio citológico de material obtenido por punción-aspiración. El tratamiento quirúrgico consistente en la resección completa de la lesión nos parece la opción más adecuada (AU)