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1.
Cir. Esp. (Ed. impr.) ; 99(1): 27-33, ene. 2021. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-200218

RESUMO

INTRODUCCIÓN: La neoplasia quística hepática es una neoplasia poco frecuente, que representa aproximadamente el 5% de las lesiones quísticas del hígado. El diagnóstico preoperatorio es difícil y puede causar confusión. El objetivo del estudio es analizar una serie de casos operados en nuestro centro con diagnóstico anatomopatológico de neoplasia quística hepática y describir la sintomatología, diagnóstico y tratamiento de acuerdo con la actual clasificación. MÉTODOS: Se realizó un análisis retrospectivo de todas las neoplasias quísticas hepáticas operadas entre enero de 2000 y diciembre de 2019. El estudio se basó en los informes de anatomía patológica ya existentes. Los casos anteriores al 2010 fueron reclasificados según la clasificación de la OMS del año 2010. RESULTADOS: La muestra total del estudio resultó en 10 pacientes: 6 fueron neoplasias mucinosas quísticas hepáticas y 4 neoplasias papilares intraductales biliares. La mayoría de los pacientes fueron mujeres (8/10) y la edad media fue de 47 años. En cuanto al tratamiento, hubo 3 hepatectomías y 7 enucleaciones. En ningún caso se realizó una biopsia intraoperatoria de los márgenes quirúrgicos. En un caso se observó atipia celular variable con zonas de adenocarcinoma, por lo que el paciente recibió quimioterapia adyuvante con taxol y carboplatino. En todos los casos los márgenes de resección fueron negativos. CONCLUSIÓN: Las neoplasias quísticas hepáticas son tumores poco frecuentes, que plantean un dilema en el diagnóstico diferencial, por lo que, ante la sospecha radiológica, el tratamiento de elección debería ser la resección completa del tumor para evitar su malignización y la recidiva


INTRODUCTION: The hepatic cystic tumour is a very rare neoplasm, representing about 5% of all cystic liver neoplasms. The preoperative diagnosis is difficult and can lead to confusion. The aim of this study is to analyze a number of cases operated at our centre with an histologic diagnosis of liver cystic neoplasms and also to describe the sintomathology, diagnosis and management as per the recent classification. METHODS: A retrospective analysis was performed including all the cystic liver neoplasms operated between January 2000 and December 2019. The study was performed based on the pre-existing pathology archives. The 2010 previous cases were reclassified following the new 2010 OMS classification. RESULTS: The study sample was of 10 patients, identifying 6 of them as mucinous cystic liver neoplasms, and the other 4 as intraductal papillary biliary neoplasms. The majority of the patients were women (8/10) and the median age was 47 years. Regarding the treatment, 3 hepatectomy and 7 enucleations were performed. Frozen section intraoperatively was not required in any case. In one case, variable cellular atypia with areas of adenocarcinoma was observed, and the patient received neoadyuvant chemotherapy with taxol and carboplatin. In all cases the resection margins were negative. CONCLUSION: Cystic liver neoplasms are infrequent tumours with a difficult differential diagnosis. Therefore, with a high radiological suspicious, the treatment should be a complete resection to avoid recurrences and malignancies


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/cirurgia , Hepatectomia/métodos , Adenocarcinoma/tratamento farmacológico , Hemoperitônio/cirurgia , Neoplasias Hepáticas/classificação , Patologia/métodos , Quimioterapia Adjuvante/métodos , Carboplatina/uso terapêutico , Estudos Retrospectivos , Dor Abdominal/etiologia , Biomarcadores Tumorais , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/patologia , Diagnóstico Diferencial
2.
Cir Esp (Engl Ed) ; 99(1): 27-33, 2021 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32439140

RESUMO

INTRODUCTION: The hepatic cystic tumour is a very rare neoplasm, representing about 5% of all cystic liver neoplasms. The preoperative diagnosis is difficult and can lead to confusion. The aim of this study is to analyze a number of cases operated at our centre with an histologic diagnosis of liver cystic neoplasms and also to describe the sintomathology, diagnosis and management as per the recent classification. METHODS: A retrospective analysis was performed including all the cystic liver neoplasms operated between January 2000 and December 2019. The study was performed based on the pre-existing pathology archives. The 2010 previous cases were reclassified following the new 2010 OMS classification. RESULTS: The study sample was of 10 patients, identifying 6 of them as mucinous cystic liver neoplasms, and the other 4 as intraductal papillary biliary neoplasms. The majority of the patients were women (8/10) and the median age was 47 years. Regarding the treatment, 3 hepatectomy and 7 enucleations were performed. Frozen section intraoperatively was not required in any case. In one case, variable cellular atypia with areas of adenocarcinoma was observed, and the patient received neoadyuvant chemotherapy with taxol and carboplatin. In all cases the resection margins were negative. CONCLUSION: Cystic liver neoplasms are infrequent tumours with a difficult differential diagnosis. Therefore, with a high radiological suspicious, the treatment should be a complete resection to avoid recurrences and malignancies.

3.
Rev Esp Enferm Dig ; 113(6): 473-474, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33244983

RESUMO

A 32-year-old male patient with common variable immunodeficiency (CVI), under treatment with human immunoglobulin G, experienced recurrent episodes of intestinal pseudo-obstruction that were medically treated. Imaging tests showed a non-obstructive ileal stenosis and biopsies performed during ileocolonoscopy revealed nod-ular lymphoid hyperplasia.


Assuntos
Imunodeficiência de Variável Comum , Obstrução Intestinal , Pseudo-Obstrução Intestinal , Adulto , Imunodeficiência de Variável Comum/complicações , Humanos , Imunoglobulina G , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Masculino
4.
Rev Esp Enferm Dig ; 111(12): 977-978, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31793318

RESUMO

An 84-year-old male patient presented with an umbilical mass. Upon examination, he had an umbilical lesion of approx. 2 cm that was nodular and painful on palpation. The abdominal CT showed a soft tissue mass of 20 x 22 mm in the umbilical subcutaneous tissue, associated with inflammatory changes. In addition, a hypodense tumor of 3.6 x 3.6 x 3.8 cm was seen located in the pancreatic tail, infiltrating the splenic hylum. Bloodwork revealed the following: haemoglobin 7.9 mg/dl, platelets: 175 x 100 /µl, prothrombin activity: 81%, INR: 1.13, Ca 19.9: 4289 U / ml, CEA: 4.38 ng / ml. The histopathological study of the umbilical lesion showed an adenocarcinoma with a moderately differentiated primary pancreatic origin, compatible with an umbilical metastasis of pancreatic cancer.


Assuntos
Adenocarcinoma/secundário , Neoplasias Pancreáticas/patologia , Nódulo da Irmã Maria José/patologia , Umbigo , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Idoso de 80 Anos ou mais , Humanos , Masculino , Neoplasias Pancreáticas/diagnóstico por imagem , Nódulo da Irmã Maria José/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Umbigo/diagnóstico por imagem
6.
Rev. esp. enferm. dig ; 110(4): 257-259, abr. 2018. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-174603

RESUMO

La ascitis refractaria es una complicación infrecuente que puede aparecer en el posoperatorio de un trasplante hepático y cuyo diagnóstico y tratamiento suponen un verdadero reto. Presentamos dos casos de pacientes trasplantados por cirrosis criptogénica y que en el posoperatorio inmediato cursaron con ascitis refractaria, una complicación grave que se asocia con una disminución de la supervivencia de hasta un año y afecta la calidad de vida del paciente. Tras descartar las principales causas de ascitis en nuestros pacientes, se propuso como etiología el hiperaflujo portal, una condición que se perpetúa con la circulación esplénica y que condiciona una reducción del flujo arterial hepático. Por tanto, si se consigue disminuir el aflujo arterial al bazo, disminuyen el retorno venoso y la circulación portal, mejorando el flujo arterial. Con la embolización esplénica, procedimiento que surgió hace varios años como tratamiento al fenómeno del robo de la arteria esplénica y en los casos de "small for size" en el trasplante de donante vivo, se pretende disminuir el hiperaflujo portal y, por tanto, la ascitis.En conclusión, la embolización de arteria esplénica es una opción terapéutica como tratamiento de la ascitis refractaria en el postrasplante hepático


Refractory ascites is an uncommon complication that may develop postoperatively after liver transplantation. The diagnosis and treatment of this condition is a real challenge. We report two cases of patients who underwent a transplant due to cryptogenic cirrhosis and developed refractory ascites during the immediate postoperative period. This is a serious complication associated with decreased survival by up to one year and a reduced quality of life. After ruling out the main causes of ascites, a portal hyperflow was a potential etiology. This condition perpetuates itself with splenic circulation and brings about a reduction in the hepatic arterial flow. Therefore, if arterial blood flow to the spleen is diminished, venous return and portal circulation will be reduced and arterial blood flow will improve. Splenic artery embolization is a procedure introduced many years ago for the management of splenic artery steal syndrome and small-for-size living donor liver transplantation. This procedure is performed in order to reduce portal hyperflow and consequently, ascites. In conclusion, splenic artery embolization is a therapeutic option for the treatment of refractory ascites after liver transplantation


Assuntos
Humanos , Masculino , Feminino , Idoso , Ascite/cirurgia , Embolização Terapêutica/métodos , Transplante de Fígado/efeitos adversos , Baço , Ascite/etiologia , Cirrose Hepática Biliar/cirurgia , Resultado do Tratamento , Angiografia/métodos
7.
Rev Esp Enferm Dig ; 110(4): 257-259, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29411988

RESUMO

Refractory ascites is an uncommon complication that may develop postoperatively after liver transplantation. The diagnosis and treatment of this condition is a real challenge. We report two cases of patients who underwent a transplant due to cryptogenic cirrhosis and developed refractory ascites during the immediate postoperative period. This is a serious complication associated with decreased survival by up to one year and a reduced quality of life. After ruling out the main causes of ascites, a portal hyperflow was a potential etiology. This condition perpetuates itself with splenic circulation and brings about a reduction in the hepatic arterial flow. Therefore, if arterial blood flow to the spleen is diminished, venous return and portal circulation will be reduced and arterial blood flow will improve. Splenic artery embolization is a procedure introduced many years ago for the management of splenic artery steal syndrome and small-for-size living donor liver transplantation. This procedure is performed in order to reduce portal hyperflow and consequently, ascites. In conclusion, splenic artery embolization is a therapeutic option for the treatment of refractory ascites after liver transplantation.


Assuntos
Ascite/cirurgia , Embolização Terapêutica/métodos , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Baço/cirurgia , Idoso , Ascite/etiologia , Feminino , Humanos , Cirrose Hepática Biliar/cirurgia , Masculino , Resultado do Tratamento
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