RESUMO
Resumen La lesión de Dieulafoy representa aproximadamente el 2% de todos los casos de hemorragia gastrointestinal superior. En la mayoría de casos esta anomalía se ubica en el estómago, principalmente en la curvatura menor. Se presenta el caso de un adulto joven con hematemesis y signos de hipovolemia. Durante la esofagogastroduodenoscopia se evidenció un coágulo adherido en el cuerpo gástrico a nivel de la curvatura mayor, sugestivo de lesión de Dieulafoy. Inicialmente se realizó manejo médico sin mejoría significativa, por lo que se realizó laparotomía exploratoria con resección de la malformación vascular, finalmente con el informe histopatológico se confirmó el diagnóstico. A pesar de ser una causa infrecuente de hemorragia gastrointestinal superior, la lesión de Dieulafoy debe considerarse entre los diagnósticos diferenciales, especialmente si la hemorragia persiste aún con manejo médico. MÉD.UIS.2019;32(i):27-31.
Abstract Dieulafoy's lesion represents approximately 2% of all causes of upper gastrointestinal bleeding. In most cases, this malformation is located in the stomach, mainly in the lesser curvature. We present the case of a young adult with hematemesis and signs of hypovolaemia. During the esophagogastroduodenoscopy, a clot adhering to the gastric body was seen at the level of the greater curvature, suggestive of Dieulafoy's lesion. Initially, medical management was performed without significant improvement, so an exploratory laparotomy was performed with resection of the vascular malformation, the histopathological report confirmed the diagnosis. Despite being an uncommon cause of upper gastrointestinal bleeding, the Dieulafoy lesion must be considered among the differential diagnoses, especially if the hemorrhage persists even with medical management. MÉD.UIS.2019;32(1):27-31.
Assuntos
Humanos , Masculino , Adulto , Malformações Vasculares , Patologia Cirúrgica , Gastroenteropatias , Hemorragia Gastrointestinal , LaparotomiaRESUMO
Resumen ANTECEDENTES El cáncer de ovario es una importante causa de muerte de mujeres, responsable de 150,000 fallecimientos anuales en el mundo, con una supervivencia a 5 años inferior a 45%. OBJETIVO Exponer los avances en diagnóstico y tratamiento de la carcinogénesis de los tumores serosos ováricos y las repercusiones de los nuevos conceptos en el tratamiento clínico y quirúrgico. METODOLOGÍA Estudio retrospectivo basado en la búsqueda sistemática de artículos con las palabras clave (MeSH): neoplasmas serosos de ovario, carcinogénesis, carcinoma seroso de bajo grado y carcinoma seroso de alto grado. La selección de los artículos estuvo a cargo, de forma independiente, de dos investigadores. De la misma forma dos patólogos evaluaron los artículos preseleccionados. RESULTADOS Se seleccionaron y analizaron 66 artículos. CONCLUSIONES Para la creación y adopción de estrategias en prevención primaria, diagnóstico y tratamiento de esta patología se requiere mayor comprensión de la fisiopatología y de los hallazgos encontrados en la última década, sobre todo los relacionados con las mutaciones en el gen BRCA, antecedentes familiares de tumores serosos del ovario, cáncer de mama o peritoneal de tipo epitelial, entre otras. La atención multidisciplinaria y actualizada repercutirá, significativamente, en la supervivencia de las pacientes.
Abstract BACKGROUND Globally, ovarian cancer is the seventh neoplasm and the eight oncologic cause of death in women, responsible of 150,000 deaths per year, with a 5 year survival under the 45%, mainly represented by high-grade serous carcinomas. Findings such as serous intraepithelial carcinomas and genetic predisposition have become a constant for the vast majority of cases. OBJECTIVE To summarize and review the most recent advances about the carcinogenesis of the ovarian serous tumors, its implications on the pathological diagnosis and the consequences of these new concepts for the clinical and surgical therapies. MATERIALS AND METHODS We performed a systematic search to select all kinds of languages articles, using the keywords "serous ovarian neoplasms" AND "carcinogenesis" AND "low-grade serous carcinoma" OR "high-grade serous carcinoma". Two investigators independently extracted characteristics and results to select the articles. Two pathologists independently did the assessment of the preselected articles selecting the most appropriate ones, based on their utility for this review. RESULTS 66 articles were selected and included in the bibliography for this review. CONCLUSIONS A better understanding of the physiopathology and many other new findings that have been done during the last decade are essential for the treatment of this patients, for the creation and application of strategies for primary prevention and screening for the risk, and the medical and surgical interventions, mainly directed to patients with mutations on BRCA, family history of breast, ovarian or peritoneal cancer, among other conditions. A multidisciplinary and updated approach will affect significantly the long-term survival.
RESUMO
El carcinoma de glándulas sebáceas es un tumor infrecuente que puede desarrollarse a partir de cualquier glándula sebácea en la piel. El 75 por ciento de las veces es de origen ocular y afecta principalmente las glándulas de Zeiss, Meibomio y de la carúncula. Se caracteriza por un comportamiento agresivo, con alta probabilidad de invasión a piel, conjuntiva y córnea. Sin embargo, el compromiso de la conjuntiva como localización primaria es raro. Se presenta un caso con diagnóstico de carcinoma sebáceo de patrón nodular primario de la conjuntiva bulbar, atendido en el Hospital Universitario de Santander durante los años 2014-2016. El propósito del presente estudio es dar a conocer el caso de una patología infrecuente con pocos casos reportados en la literatura, enfatizar su importancia dentro de los diagnósticos diferenciales de masas en la conjuntiva y del estudio histopatológico como método para obtener un diagnóstico definitivo y realizar un abordaje temprano(AU)
Sebaceous gland carcinoma is an uncommon tumor that may derive from any sebaceous gland of the skin. In 75 percent of cases is ocular and mainly affects the Zeiss, Melbonium and caruncle glands. It is characterized for its aggressiveness, high probability of passing into the skin, the conjunctiva and the cornea. However, the involvement of the conjunctiva as a primary location is rare. This is a case diagnosed with sebaceous carcinoma of primary nodullary pattern of the bulb conjunctiva, which was seen at the university hospital of Santander from 2014 to 2016. The objective of the study was to show the case of an infrequent pathology with very few cases reported up to now in literature, to make emphasis on its importance within the differential diagnoses of masses present in the conjunctiva and of the histopathological study as a method to obtain a final diagnosis and to make an early intervention(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma/diagnóstico , Neoplasias da Túnica Conjuntiva/diagnóstico , Glândulas Sebáceas/patologia , Túnica Conjuntiva/lesõesRESUMO
El carcinoma de glándulas sebáceas es un tumor infrecuente que puede desarrollarse a partir de cualquier glándula sebácea en la piel. El 75 por ciento de las veces es de origen ocular y afecta principalmente las glándulas de Zeiss, Meibomio y de la carúncula. Se caracteriza por un comportamiento agresivo, con alta probabilidad de invasión a piel, conjuntiva y córnea. Sin embargo, el compromiso de la conjuntiva como localización primaria es raro. Se presenta un caso con diagnóstico de carcinoma sebáceo de patrón nodular primario de la conjuntiva bulbar, atendido en el Hospital Universitario de Santander durante los años 2014-2016. El propósito del presente estudio es dar a conocer el caso de una patología infrecuente con pocos casos reportados en la literatura, enfatizar su importancia dentro de los diagnósticos diferenciales de masas en la conjuntiva y del estudio histopatológico como método para obtener un diagnóstico definitivo y realizar un abordaje temprano(AU)
Sebaceous gland carcinoma is an uncommon tumor that may derive from any sebaceous gland of the skin. In 75 percent of cases is ocular and mainly affects the Zeiss, Melbonium and caruncle glands. It is characterized for its aggressiveness, high probability of passing into the skin, the conjunctiva and the cornea. However, the involvement of the conjunctiva as a primary location is rare. This is a case diagnosed with sebaceous carcinoma of primary nodullary pattern of the bulb conjunctiva, which was seen at the university hospital of Santander from 2014 to 2016. The objective of the study was to show the case of an infrequent pathology with very few cases reported up to now in literature, to make emphasis on its importance within the differential diagnoses of masses present in the conjunctiva and of the histopathological study as a method to obtain a final diagnosis and to make an early intervention(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma/diagnóstico , Neoplasias da Túnica Conjuntiva/diagnóstico , Glândulas Sebáceas/patologia , Túnica Conjuntiva/lesõesRESUMO
Los ginandroblastomas son tumores del ovario extremadamente raros, los cuales comparten componentes de células de la granulosa y de células de Sertoli/Leydig. Se describe un caso de una niña de 12 años, quien presenta hemorragia uterina anormal y sensación de masa intraabdominal de crecimiento progresivo asociado a menorragia, niveles de CA-125 en 60,4 UI/mL y estudios de extensión que reportan masa quística en ovario izquierdo, manejada con ooforectomía. El estudio anatomopatológico muestra un tumor multiloculado lleno de material seroso, abundantes cuerpos de Call-Exner y 45% de células de Sertoli/Leydig. La inmunohistoquímica reveló inmunorreactividad para inhibina, calretinina y pCK, mientras que los marcadores CD99 y AE1/AE3 fueron negativos. Se trata del primer reporte de caso sobre un ginandroblastoma multiloculado, negativo para CD99 en una niña de 12 años, estudio que plantea un abordaje sistemático para los tumores de las células de los cordones sexuales.
The ginandroblastoma is an extremely rare ovarian tumor which shows components of granulosa cells and Sertoli/Leydig cells. We describe a case of a twelve-years-old girl who presented abnormal uterine bleeding and progressively growing intra- abdominal mass associated with menorrhagia, CA-125 60.4 UI/mL and extension studies reporting cystic mass in the left ovary. She underwent oophorectomy. Pathological study shows a multilocular tumor filled with serous material. Many Call-Exner bodies were observed in the histopathological analysis, 45% of Sertoli/Leydig cells. Immunohistochemistry was reactive for inhibin, calretinin and pCK while AE1/AE3 and CD99 markers were negative. This is the first case report about a multiloculated gynandroblastoma, negative for CD99 in a 12-years-old girl. Thus, the study of this clinical case represents a systematic approach for tumors of the sex cord cells.
Assuntos
Humanos , Feminino , Criança , Neoplasias Ovarianas/sangue , Biomarcadores Tumorais/sangue , Antígenos CD/sangue , Moléculas de Adesão Celular/sangue , Tumores do Estroma Gonadal e dos Cordões Sexuais/sangue , Neoplasias Ovarianas/patologia , Tumores do Estroma Gonadal e dos Cordões Sexuais/patologia , Antígeno 12E7RESUMO
The ginandroblastoma is an extremely rare ovarian tumor which shows components of granulosa cells and Sertoli/Leydig cells. We describe a case of a twelve-years-old girl who presented abnormal uterine bleeding and progressively growing intraabdominal mass associated with menorrhagia, CA-125 60.4 UI/mL and extension studies reporting cystic mass in the left ovary. She underwent oophorectomy. Pathological study shows a multilocular tumor filled with serous material. Many Call-Exner bodies were observed in the histopathological analysis, 45% of Sertoli/Leydig cells. Immunohistochemistry was reactive for inhibin, calretinin and pCK while AE1/AE3 and CD99 markers were negative. This is the first case report about a multiloculated gynandroblastoma, negative for CD99 in a 12-years-old girl. Thus, the study of this clinical case represents a systematic approach for tumors of the sex cord cells.
Assuntos
Antígenos CD/sangue , Biomarcadores Tumorais/sangue , Moléculas de Adesão Celular/sangue , Neoplasias Ovarianas/sangue , Tumores do Estroma Gonadal e dos Cordões Sexuais/sangue , Antígeno 12E7 , Criança , Feminino , Humanos , Neoplasias Ovarianas/patologia , Tumores do Estroma Gonadal e dos Cordões Sexuais/patologiaRESUMO
The ginandroblastoma is an extremely rare ovarian tumor which shows components of granulosa cells and Sertoli/Leydig cells. We describe a case of a twelve-years-old girl who presented abnormal uterine bleeding and progressively growing intraabdominal mass associated with menorrhagia, CA-125 60.4 UI/mL and extension studies reporting cystic mass in the left ovary. She underwent oophorectomy. Pathological study shows a multilocular tumor filled with serous material. Many Call-Exner bodies were observed in the histopathological analysis, 45
of Sertoli/Leydig cells. Immunohistochemistry was reactive for inhibin, calretinin and pCK while AE1/AE3 and CD99 markers were negative. This is the first case report about a multiloculated gynandroblastoma, negative for CD99 in a 12-years-old girl. Thus, the study of this clinical case represents a systematic approach for tumors of the sex cord cells.