Carney triad: A case report, characteristics and literature review of this rare entity.

INTRODUCTION AND IMPORTANCE: Carney triad is a rare entity of unknown etiology, characterized by the association of tumors with low incidence such as: gastric leiomyosarcoma, pulmonary chondroma and extra-adrenal paraganglioma. We show a case of Carney triad diagnosed in our center that has some different characteristics to the typical presentation of this patology, and a review of the literature. CASE PRESENTATION: We present the case of a 47-year-old men who was admitted to our hospital for upper gastrointestinal bleeding and anemia. The patient was diagnosed of gastric GIST (gastrointestinal stromal tumor), pulmonary nodule and retroperitoneal nodule close to iliac bifurcation. A review of his medical history revealed that he had undergone surgery at 18-year-old for gastric leiomiosarcoma, subtotal gastrectomy performed with gastroenteric anastomosis type Billroth II. The patient underwent total gastrectomy with a end-lateral esophago-jejune mechanical anastomosis and retroperitoneal tumor was also excised. Pathological result confirmed gastric GIST, and extra-adrenal paraganglioma. CLINICAL DISCUSSION: We review the available literature to determinate the characteristics and the most appropriate management for this syndrome. The trend is surgical treatment of gastric GIST and paraganglioma, preferred conservative treatment in pulmonary chondroma. It is under discussion whether gastric tumors Carney syndrome is considered GIST, because the Carney triad lesions in stomach are different clinically, pathologically, and etiologically from GIST of stomach. CONCLUSION: Carney's triad is a low prevalence entity, with a limited number of publications, so the presentation of the syndrome may be different from the presentation described in the literature.

Significado del líquido libre perigástrico identificado por ecoendoscopia en pacientes con cáncer gástrico / No disponible

Objetivos: Determinar el valor diagnóstico del líquido libre perigástrico identificado por ecoendoscopia en pacientes con cáncer gástirico y establecer los factores relacionados con la presencia de carcinomatosis peritoneal en estos pacientes. Material y métodos Se incluyeron de modo retrospectivo 100 pacientes con diagnóstico histológico de adenocarcinoma gástrico enviados para la realización de ecoendoscopia. Se consideró como resultado positivo la identificación por ecoendoscopia de líquido libre perigástrico. Se comparó este resultado con el estudio final basado en la laparoscopia-laparotomía exploradora. Se compararon las características histológicas y endoscópicas con respecto al resultado final. Resultados En 21 pacientes (21%) se identificó la presencia de líquido libre perigástrico, en 15 de los cuales (71%) se confirmó la existencia de carcinomatosis peritoneal mediante laparoscopia (12 casos) o punción-aspiración con aguja fina (PAAF) guiada por ecoendoscopia (3 casos). En 7 de los 79 pacientes (8%) en los que no se observó la presencia de ascitis se identificaron implantes peritoneales en la laparoscopia-laparotomía exploradora. La sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y exactitud diagnóstica del líquido libre para el diagnóstico de carcinomatosis fueron del 68, 92, 71, 91 y 87%, respectivamente. No se identificaron factores histológicos o endoscópicos relacionados con la naturaleza maligna del líquido observado por ecoendoscopia. Conclusión En pacientes con cáncer gástrico, el líquido libre perigástrico identificado por ecoendoscopia es un importante factor predictivo de carcinomatosis peritoneal y puede tener importantes implicaciones en el manejo de estos pacientes (AU)

Objectives: To determine the diagnostic value of free perigastric fluid identified by echoendoscopy in patients with gastric cancer and to establish the factors related to the presence of peritoneal carcinomatosis in these patients. Material and methods: We retrospectively included 100 patients with a histological diagnosisof gastric adenocarcinoma referred for echoendoscopy. A positive result was defined as the echoendoscopic identification of free perigastric fluid. This result was compared with the final study based on exploratory laparoscopy-laparotomy. The histological and endoscopic characteristics were compared with the final result. Results: Free perigastric fluid was found in 21 patients (21%). Among these, 15 (71%) showed peritoneal carcinomatosis, confirmed by laparoscopy (12 patients) or echoendoscopy-guidedfine-needle-aspiration biopsy (three patients). In seven of the 79 patients (8%) not showing the presence of ascites, peritoneal implants were identified by exploratory laparoscopy-laparotomy. The sensitivity, specificity, positive predictive value and diagnostic accuracy of free fluid in the diagnosis of carcinomatosis was 68%, 92%, 71%, 91% and 87%, respectively. No histologicor endoscopic factors related to the malignancy of echoendoscopically-detected fluid wereidentified. Conclusion: In patients with gastric cancer, free perigastric fluid identified by echoendoscopyis an important predictive factor of peritoneal carcinomatosis and may have significant implications in the management of these patients (AU)

[Significance of free perigastric fluid detected by echoendoscopy in patients with gastric cancer]. / Significado del líquido libre perigástrico identificado por ecoendoscopia en pacientes con cáncer gástrico.

OBJECTIVES: To determine the diagnostic value of free perigastric fluid identified by echoendoscopy in patients with gastric cancer and to establish the factors related to the presence of peritoneal carcinomatosis in these patients. MATERIAL AND METHODS: We retrospectively included 100 patients with a histological diagnosis of gastric adenocarcinoma referred for echoendoscopy. A positive result was defined as the echoendoscopic identification of free perigastric fluid. This result was compared with the final study based on exploratory laparoscopy-laparotomy. The histological and endoscopic characteristics were compared with the final result. RESULTS: Free perigastric fluid was found in 21 patients (21%). Among these, 15 (71%) showed peritoneal carcinomatosis, confirmed by laparoscopy (12 patients) or echoendoscopy-guided fine-needle-aspiration biopsy (three patients). In seven of the 79 patients (8%) not showing the presence of ascites, peritoneal implants were identified by exploratory laparoscopy-laparotomy. The sensitivity, specificity, positive predictive value and diagnostic accuracy of free fluid in the diagnosis of carcinomatosis was 68%, 92%, 71%, 91% and 87%, respectively. No histologic or endoscopic factors related to the malignancy of echoendoscopically-detected fluid were identified. CONCLUSION: In patients with gastric cancer, free perigastric fluid identified by echoendoscopy is an important predictive factor of peritoneal carcinomatosis and may have significant implications in the management of these patients.

Dos casos de complicaciones por pólipo fibrovascular gigante del esófago / Two cases of complications due to a giant fibrovascular polyp of the oesophagus

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Diagnóstico serológico de gastritis atrófica con una combinación de pepsinógeno I y II, gastrina-17 y anticuerpos anti-Helicobacter pylori / Serological diagnosis of atrophic gastritis with a combination of pepsinogen I and II, gastrin-17 and anti-Helicobacter pylori antibodies

Objetivo: El diagnóstico no invasivo de gastritis atrófica ayudaría a identificar individuos con un riesgo elevado de carcinoma gástrico. En este estudio se ha evaluado la utilidad de un panel serológico que combina pepsinógeno I y II, gastrina-17 y anticuerpos anti-Helicobacter pylori (Gastropanel) como método de cribado de la gastritis atrófica. Pacientes y métodos: El panel serológico se evaluó en 56 pacientes de dos grupos: a) 47 pacientes con dispepsia no investigada, y b) 9 pacientes consecutivos con carcinoma gástrico. En todos ellos se realizó una endoscopia con toma de biopsias del antro y el cuerpo gástricos. Los valores de pepsinógeno I y II, gastrina-17 y anticuerpos anti-H. pylori se determinaron mediante test EIA específicos (Biohit plc, Helsinki, Finlandia) en muestras de suero de los pacientes obtenidas en ayunas. Resultados: La gastritis atrófica fue significativamente más frecuente en los pacientes con carcinoma gástrico que en los pacientes dispépticos (el 56 frente al 6%; p = 0,0015). El grado de concordancia entre el panel serológico y la histología gástrica fue bueno (kappa = 0,68). La sensibilidad y la especificidad del panel serológico para diagnosticar la gastritis atrófica fueron del 87,5 y el 100%, respectivamente. Sin embargo, el panel serológico no habría detectado 4 de los 9 casos de carcinoma gástrico, ya que se originaron en un estómago con mucosa no atrófica. Conclusiones: El panel serológico es un método no invasivo útil para el diagnóstico de gastritis atrófica. Sin embargo, su utilidad como método de cribado está limitada por la existencia de casos de carcinoma gástrico que aparecen en estómagos sin atrofia mucosa

Objective: Noninvasive diagnosis of atrophic gastritis would help to identify individuals at increased risk of gastric carcinoma. In the present study, we evaluated the utility of a serological panel combining pepsinogen I and II, gastrin-17, and anti-Helicobacter pylori antibodies (Gastropanel) as a screening method for atrophic gastritis. Patients and methods: The serological panel was evaluated in 56 patients divided in two groups: group 1 consisted of 47 patients with uninvestigated dyspepsia and group 2 was composed of nine consecutive patients with gastric carcinoma. In all patients, we performed endoscopy with biopsies of the gastric antrum and body. Levels of pepsinogen I and II, gastrin-17, and anti-H. pylori antibodies were determined through a specific EIA test (Biohit plc, Helsinki, Finland) in fasting serum samples. Results: Atrophic gastritis was significantly more frequent in patients with gastric carcinoma than in those with dyspepsia (56 vs 6%; p = 0.0015). Agreement between the Gastropanel and gastric histology was good (kappa = 0.68). The sensitivity and specificity of the Gastropanel in the diagnosis of atrophic gastritis was 87.5% and 100%, respectively. However, the Gastropanel would not have detected four of the nine cases of gastric carcinoma, since these tumors arose in stomachs with nonatrophic mucosa. Conclusions: Gastropanel is a useful noninvasive method for the diagnosis of atrophic gastritis. However, its utility as a screening method is limited by cases of gastric carcinoma that arise in stomachs without atrophic mucosa

[Stromal tumors of the jejunum and obscure gastrointestinal bleeding. Use of minimally invasive techniques in three cases]. / Tumores estromales yeyunales y hemorragia digestiva oculta. Empleo de técnicas mínimamente invasivas en tres casos clínicos.

Gastrointestinal bleeding is considered to be obscure when routine endoscopic techniques (esophagogastroscopy and colonoscopy) fail to identify the origin of the hemorrhage. These hemorrhages represent 5% of all gastrointestinal bleeding. Twenty-seven percent of these hemorrhages are due to small bowel disease and gastrointestinal stromal tumors (GIST) are a frequent cause, especially in middle-aged patients. We present three cases that illustrate the difficulty of diagnosing this clinical entity. We emphasize the use of minimally invasive techniques such as computed tomography and laparoscopic surgery in the complicated management of these patients. We believe that the use of these techniques could avoid the need for other more aggressive procedures and allow the application of early definitive surgical treatment with the advantages of laparoscopic surgery.

[Serological diagnosis of atrophic gastritis with a combination of pepsinogen I and II, gastrin-17 and anti-Helicobacter pylori antibodies]. / Diagnóstico serológico de gastritis atrófica con una combinación de pepsinógeno I y II, gastrina-17 y anticuerpos anti-Helicobacter pylori.

OBJECTIVE: Noninvasive diagnosis of atrophic gastritis would help to identify individuals at increased risk of gastric carcinoma. In the present study, we evaluated the utility of a serological panel combining pepsinogen I and II, gastrin-17, and anti-Helicobacter pylori antibodies (Gastropanel) as a screening method for atrophic gastritis. PATIENTS AND METHODS: The serological panel was evaluated in 56 patients divided in two groups: group 1 consisted of 47 patients with uninvestigated dyspepsia and group 2 was composed of nine consecutive patients with gastric carcinoma. In all patients, we performed endoscopy with biopsies of the gastric antrum and body. Levels of pepsinogen I and II, gastrin-17, and anti-H. pylori antibodies were determined through a specific EIA test (Biohit plc, Helsinki, Finland) in fasting serum samples. RESULTS: Atrophic gastritis was significantly more frequent in patients with gastric carcinoma than in those with dyspepsia (56 vs 6%; p = 0.0015). Agreement between the Gastropanel and gastric histology was good (kappa = 0.68). The sensitivity and specificity of the Gastropanel in the diagnosis of atrophic gastritis was 87.5% and 100%, respectively. However, the Gastropanel would not have detected four of the nine cases of gastric carcinoma, since these tumors arose in stomachs with nonatrophic mucosa. CONCLUSIONS: Gastropanel is a useful noninvasive method for the diagnosis of atrophic gastritis. However, its utility as a screening method is limited by cases of gastric carcinoma that arise in stomachs without atrophic mucosa.

Tumores estromales yeyunales y hemorragia digestiva oculta. Empleo de técnicas mínimamente invasivas en tres casos clínicos / Stromal tumors of the jejunum and obscure gastrointestinal bleeding. Use of minimally invasive techniques in three cases

Se considera hemorragia digestiva oculta cuando las técnicas habituales endoscópicas (esofagogastroscopia y colonoscopia) no encuentran el origen de la hemorragia. Esta hemorragia supone el 5% de todas las hemorragias digestivas. El 27% de las hemorragias ocultas son por lesiones de intestino delgado; los tumores estromales (GIST) son una causa frecuente, fundamentalmente en pacientes de mediana edad. Presentamos 3 casos que reflejan la dificultad en el diagnóstico de este cuadro clínico y destacamos el empleo de técnicas poco invasivas, como la tomografía computarizada y la cirugía laparoscópica, en el complicado manejo de estos enfermos. Creemos que la incorporación de estas técnicas podría evitar otros procedimientos más agresivos y permiten aplicar el tratamiento definitivo quirúrgico de forma temprana con las ventajas de la cirugía laparoscópica (AU)

Gastrointestinal bleeding is considered to be obscure when routine endoscopic techniques (esophagogastroscopy and colonoscopy) fail to identify the origin of the hemorrhage. These hemorrhages represent 5% of all gastrointestinal bleeding. Twenty-seven percent of these hemorrhages are due to small bowel disease and gastrointestinal stromal tumors (GIST) are a frequent cause, especially in middle-aged patients. We present three cases that illustrate the difficulty of diagnosing this clinical entity. We emphasize the use of minimally invasive techniques such as computed tomography and laparoscopic surgery in the complicated management of these patients. We believe that the use of these techniques could avoid the need for other more aggressive procedures and allow the application of early definitive surgical treatment with the advantages of laparoscopic surgery (AU)