RESUMO
Prevention of progression to invasive carcinoma in patients with a premalignant endometrial lesion using longterm treatment with levonorgestrel (LNG) releasing intrauterine systems (IUS) remains controversial, especially when manifest cellular atypia has been found in the endometrial biopsy specimen. We present a case of a 44-year old premenopausal woman with a premalignant uterine polyp who declined hysterectomy and was followed-up for more than 12 years after the first LNG-IUS was inserted. Endometrial atrophy installed, no pathology was detected and hysterectomy was thereby successfully avoided. The positive experience in this case should encourage further studies as literature data indicate that conservative treatment of premalignant endometrial pathology is a real option with a high success rate for women who have a contra-indication for surgery, refuse the classical approach for personal reasons or want to preserve their fertility.
RESUMO
Curative resection of limited gastro-intestinal carcinoma does not always mean curation with tumor-free long-term survival. We present two cases of ultra-late recurrence 14 years after initial treatment. In the first case a 50-year-old male underwent in 1997 a subtotal esophagectomy with tubulation of the stomach for a localized Barrett carcinoma. Postoperative staging showed a poorly differentiated adenocarcinoma, pT1N1 (stage IIB). In May 2011, 14 years after the initial resection, multiple bone metastases were diagnosed and a biopsy confirmed the poorly differentiated carcinoma with the same characteristics as the primary tumor. Investigations showed no evidence for a new primary tumor. The second case is a 52-year old man who underwent a low anterior resection for a small rectal cancer in 1997, histologically a well differentiated adenocarcinoma, stage IB (pT2NO). In December 2011 multiple metastases were diagnosed and a biopsy showed a metastasis from a mucinous carcinoma, suggestive for a colorectal carcinoma. There was also no evidence for a new primary tumor. Although the prognosis of limited esophageal and colorectal cancer is good, recurrence is always possible and an ultra-late recurrence may exceptionally occur. The mechanism of tumor dormancy is described.
Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia , Recidiva Local de Neoplasia/diagnóstico , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/cirurgia , Endoscopia Gastrointestinal , Neoplasias Esofágicas/diagnóstico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
GOAL OF WORK: Totally implantable venous access ports are widely accepted in cancer patient treatment, but withdrawal occlusion (WO) can hamper the use of the device. A newly designed Vortex VX port, with a tangential outlet, should allow better clearance of the chamber, thereby reducing occlusion of the device. The present study compared the Vortex port to the classically shaped Celsite port with regards to functional complications. MATERIALS AND METHODS: Two hundred cancer patients were included in a prospective, randomised controlled trial and randomly assigned to the implantation of a Vortex or a Celsite port. Insertion details such as used vein, catheter tip position and infusion or aspiration abilities were recorded. Data were collected concerning ease of access, and functional evaluation was performed each time the port was accessed, regarding the ability to infuse fluids with a syringe and to withdraw blood by measuring the filling time of a Vacutainer blood tube. MAIN RESULTS: Ninety-nine patients received a Celsite port, and 101 had a Vortex port. Demographic variables and insertion details were comparable in both groups. All functional complications, including WO, total occlusion, sluggish inflow and sluggish withdrawal, were higher in the Celsite group (16.12%) than in the Vortex group (11.36%). This difference was not statistically significant. CONCLUSIONS: This study revealed that functional problems occurred less frequently in Vortex compared to Celsite ports. Differences were small and not significant, which indicates that functional problems may be related to other factors.
Assuntos
Cateterismo Venoso Central/instrumentação , Neoplasias , Flebotomia/instrumentação , Adulto , Idoso , Cateteres de Demora , Desenho de Equipamento , Falha de Equipamento , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos ProspectivosRESUMO
OBJECTIVES: Levonorgestrel (LNG), delivered locally into the uterine cavity has a profound effect on the endometrium. The aim of the study was to use a LNG intrauterine system to treat non-atypical and atypical endometrial hyperplasia in women and to evaluate the long-term cure (remission) rate. METHODS: Each of the 20 women in the study, of whom eight were diagnosed with atypical hyperplasia, received a LNG-IUS, releasing 20 microg LNG/day. The study is a non-comparative study with long-term follow-up (range 14-90 months). RESULTS: All women developed a normal endometrium, except one asymptomatic woman with atypical hyperplasia who still had focal residual non-atypical hyperplasia at 3 years follow-up in the presence of a thin (< 4 mm) endometrium. CONCLUSION: Continuous intrauterine delivery of LNG appears to be a promising alternative to hysterectomy for the treatment of endometrial hyperplasia and could enhance the success rate when compared with other routes of progestagen administration as well as intrauterine progesterone delivery. The significant reduction of the PR expression observed during treatment with the LNG-IUS appears to be a marker for the strong antiproliferative effect of the hormone at a cellular level resulting in an inhibition of estrogen bioactivity and endometrial suppression.
Assuntos
Hiperplasia Endometrial/tratamento farmacológico , Terapia de Reposição de Estrogênios , Dispositivos Intrauterinos Medicados , Levanogestrel/administração & dosagem , Congêneres da Progesterona/administração & dosagem , Adulto , Idoso , Hiperplasia Endometrial/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
A male patient is described with melanocytic schwannoma, atrial myxoma and spotty pigmentation in the face due to Carney complex. Remarkable findings are fertility problems with bilateral macroorchidism and oligoasthenospermia.
Assuntos
Aberrações Cromossômicas/genética , Neoplasias Cardíacas/genética , Neoplasia Endócrina Múltipla/genética , Mixoma/genética , Transtornos da Pigmentação/genética , Adulto , Aberrações Cromossômicas/diagnóstico , Transtornos Cromossômicos , Átrios do Coração , Neoplasias Cardíacas/diagnóstico , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/genética , Masculino , Neoplasia Endócrina Múltipla/diagnóstico , Mixoma/diagnóstico , Neurilemoma/diagnóstico , Neurilemoma/genética , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Neoplasias do Sistema Nervoso Periférico/genética , Transtornos da Pigmentação/diagnóstico , Raízes Nervosas Espinhais , SíndromeRESUMO
Amyloidosis confined to the duodenum is uncommon. In the present report the history of an 83-year old patient, admitted for vomiting and heavy epigastric pain, is described. Radiographic and endoscopic investigation revealed two polypoid lesions in the duodenum (D2). Biopsies showed diffuse amyloid deposition in the lamina propria, muscularis mucosae and submucosa of the duodenum as well as vascular deposits. No other localisations were documented. Amyloid tumours of the gastrointestinal tract are rare but may lead to serious symptoms.