Metástasis coroidea como primera manifestación de carcinoma papilar de tiroides: a propósito de un caso / Choroidal metastases as initial manifestation of a papillary thyroid carcinoma: A case report

Se presenta el caso de un varón de 78 años que consultó por disminución de visión en ojo derecho de meses de evolución. En la exploración funduscópica se detectó existencia de una masa coroidea de coloración amarillo-anaranjado, sin desprendimiento de retina asociado. La tomografía computarizada demostró presencia de una masa localizada en istmo tiroideo así como múltiples adenopatías y focos de diseminación de aspecto metastásico. La broncoscopia con biopsia pulmonar mostró hallazgos compatibles con diseminación metastásica. La punción-aspiración con aguja fina del nódulo tiroideo fue diagnóstica para un carcinoma papilar de tiroides subtipo células columnares y la tomografía por emisión de positrones confirmó secundarismo a carcinoma primario de tiroides. Se trató al paciente con tiroidectomía total y tratamiento sustitutivo tiroideo, y posteriormente tratamiento ablativo con radioyodo

The case is presented of 78 year-old who consulted due to decreased visual acuity in right eye for several months. Indirect ophthalmoscopy revealed an orange-yellow coloured choroidal mass at the posterior pole, without retinal detachment. Computed tomography showed a thyroid mass in the isthmus, as well as multiple pulmonary nodules and metastatic foci. The findings of transbronchial lung biopsy were compatible with metastatic dissemination. Fine-needle aspiration biopsy of thyroid nodule was diagnostic for a with columnar cell variant of papillary thyroid cancer. Positron emission tomography confirmed papillary thyroid carcinoma. The patient underwent total thyroidectomy and radioactive iodine therapy

Choroidal metastases as initial manifestation of a papillary thyroid carcinoma: A case report. / Metástasis coroidea como primera manifestación de carcinoma papilar de tiroides: a propósito de un caso.

The case is presented of 78 year-old who consulted due to decreased visual acuity in right eye for several months. Indirect ophthalmoscopy revealed an orange-yellow coloured choroidal mass at the posterior pole, without retinal detachment. Computed tomography showed a thyroid mass in the isthmus, as well as multiple pulmonary nodules and metastatic foci. The findings of transbronchial lung biopsy were compatible with metastatic dissemination. Fine-needle aspiration biopsy of thyroid nodule was diagnostic for a with columnar cell variant of papillary thyroid cancer. Positron emission tomography confirmed papillary thyroid carcinoma. The patient underwent total thyroidectomy and radioactive iodine therapy.

[Intestinal intussusception as the first manifestation of lung cancer]. / Invaginación intestinal como primera manifestación del cáncer de pulmón.

Intussusception is a rare form of intestinal obstruction in adults. Most cases are caused by malignant lesions in the intestinal wall, which in exceptional cases are caused by metastases. The initial manifestation of lung cancer as metastasis to the gastrointestinal tract is an extremely rare event. In most cases metastases are diagnosed after the primary lung tumour, when potentially life-threatening complications such as perforation, obstruction or haemorrhage develop, often requiring emergency surgery. Regardless of treatment, these patients have very poor prognosis due to the advanced stage of their disease. The study describes the case of a 48-year-old man presenting at the emergency department with a bowel obstruction of a week's duration, who was diagnosed via CT scan with small-bowel intussusception, and via chest x-ray with a suspicious lung nodule. Emergency surgery was performed, with intestinal resection of the invaginated area and anastomosis. Postoperative recovery was uneventful. The histopathological diagnosis was intestinal metastasis from lung carcinoma. Stage IV primary malignant lung tumour was confirmed, with spread through the lungs, bones, brain and metastases in both adrenal glands. Received palliative treatment with radiation and chemotherapy, and died five months after diagnosis.

Invaginación intestinal como primera manifestación del cáncer de pulmón / Intestinal intussusception as the first manifestation of lung cancer

La invaginación intestinal es una causa muy poco frecuente de obstrucción intestinal en el adulto. La mayoría están causadas por lesiones malignas en la pared intestinal, siendo excepcional que se produzcan por metástasis. La manifestación inicial del cáncer de pulmón como metástasis en el tracto gastrointestinal es un hecho extremadamente raro. En la mayoría de los casos las metástasis se diagnostican después del tumor primario pulmonar, cuando desarrollan complicaciones potencialmente mortales como perforación, obstrucción o hemorragia, que a menudo requieren una intervención quirúrgica urgente. Independientemente del tratamiento, estos pacientes tienen un pronóstico muy sombrío dado el estado avanzado de su enfermedad. Describimos el caso un hombre de 48 años con un cuadro de obstrucción intestinal de una semana de evolución, que fue diagnosticado en el servicio de Urgencias mediante tomografía computarizada de invaginación de intestino delgado, y en radiografía simple de tórax de nódulo pulmonar sospechoso. Se decidió intervención quirúrgica urgente, realizándose resección intestinal de la zona invaginada y anastomosis, presentando un postoperatorio sin incidencias. El diagnóstico anatomopatológico fue de metástasis intestinal de carcinoma de pulmón. Se confirmó el tumor maligno primario de pulmón en estadio IV, con diseminación pulmonar, ósea, cerebral y metástasis en ambas glándulas suprarrenales. Recibió tratamiento paliativo con radioterapia y quimioterapia, falleciendo transcurridos 5 meses del diagnóstico (AU)

Intussusception is a rare form of intestinal obstruction in adults. Most cases are caused by malignant lesions in the intestinal wall, which in exceptional cases are caused by metastases. The initial manifestation of lung cancer as metastasis to the gastrointestinal tract is an extremely rare event. In most cases metastases are diagnosed after the primary lung tumour, when potentially life-threatening complications such as perforation, obstruction or haemorrhage develop, often requiring emergency surgery. Regardless of treatment, these patients have very poor prognosis due to the advanced stage of their disease. The study describes the case of a 48-year-old man presenting at the emergency department with a bowel obstruction of a week's duration, who was diagnosed via CT scan with small-bowel intussusception, and via chest x-ray with a suspicious lung nodule. Emergency surgery was performed, with intestinal resection of the invaginated area and anastomosis. Postoperative recovery was uneventful. The histopathological diagnosis was intestinal metastasis from lung carcinoma. Stage IV primary malignant lung tumour was confirmed, with spread through the lungs, bones, brain and metastases in both adrenal glands. Received palliative treatment with radiation and chemotherapy, and died five months after diagnosis (AU)

Metástasis cutáneas de cáncer de recto / Cutaneous metastases from rectal cancer

El carcinoma colorrectal es un tumor que con muy poca frecuencia origina metástasis cutáneas, y cuando lo hace raramente es por vía hematógena. Presentamos el caso de un varón de 55 años diagnosticado de un adenocarcinoma de recto (tercio inferior) estadioT3N2M0. Tratado inicialmente con radioquimioterapia neoadyuvante, fue intervenido ocho semanas después realizándose una amputación abdominoperineal extendida. El resultado anatomopatológico fue de adenocarcinoma mucinoso de recto, estadio ypT3bN1. Tras un postoperatorio sin complicaciones el paciente recibió tratamiento quimioterápico con capecitabina. A los 18 meses el paciente refirió la aparición progresiva de nódulos subcutáneos en distintas localizaciones. En la tomografía computarizada de control se objetivaron múltiples imágenes sugestivas de metástasis a nivel hepático y pulmonar, así como lesiones subcutáneas. La exéresis-biopsia de uno de los nódulos subcutáneos corroboró la sospecha de metástasis de adenocarcinoma de recto. Se valoró tratamiento quimioterápico que no llegó a administrarse por el rápido deterioro del paciente que llevó al exitus (AU)

Colorectal carcinoma is a tumour that very infrequently gives rise to cutaneous metastases and when it does so, it is rarely by the haematogenous route. We present the case of a 55-year old male diagnosed with anadenocarcinoma of the rectum (lower third), clinical stageT3N2M0. Initially treated with neoadjuvant radiochemotherapy, he was operated on eight weeks later, with an extended abdominoperineal amputation. The anatomopathological result was mucinous adenocarcinoma of the rectum, clinical stage ypT3bN1. Following a postoperative period without complications, the patient received chemotherapeutic treatment with capecitabine. Eighteen months later the patient reported the progressive appearance of subcutaneous nodules in different localizations. In the computerized tomography test multiple images were objectivized suggesting metastasis at the hepatic and pulmonary levels, as well as subcutaneous lesions. The biopsy-excision of one of the subcutaneous nodules corroborated the suspicion of metastasis of the adenocarcinoma of the rectum. Chemotherapy treatment was considered for the patient, which was not administered due to the rapid deterioration of the patient leading to his death (AU)

[Cutaneous metastases of rectal cancer]. / Metástasis cutáneas de cáncer de recto.

Colorectal carcinoma is a tumour that very infrequently gives rise to cutaneous metastases and when it does so, it is rarely via the haematogenous route. We present the case of a 55-year old male diagnosed with an adenocarcinoma of the rectum (lower third), clinical stage T3N2M0. Initially treated with neoadjuvant radiochemotherapy, he was operated on eight weeks later, with an extended abdominoperineal amputation. The anatomopathological result was mucinous adenocarcinoma of the rectum, clinical stage ypT3bN1. Following a postoperative period without complications, the patient received chemotherapeutic treatment with capecitabine. Eighteen months later the patient reported the progressive appearance of subcutaneous nodules in different localizations. In the computerized tomography test multiple images were objectivized suggesting metastasis at the hepatic and pulmonary levels, as well as subcutaneous lesions. The biopsy-excision of one of the subcutaneous nodules corroborated the suspicion of metastasis of the adenocarcinoma of the rectum. Chemotherapy treatment was considered for the patient, which was not administered due to the rapid deterioration of the patient leading to his death.

[An analysis of the referrals to specialist consultations made in a health center]. / Análisis de las derivaciones a las consultas de especialistas realizadas en un centro de salud.

The study of referrals from primary care areas permits the evaluation of health care in this level and reveals the educational requirements of the specialists in family medicine. Between January and April 1988 a prospective study was carried out to evaluate the referrals to the second level of care in the health center V Centenario. In 27,657 visits 1,906 referrals to the different specialties were ordered, which represents a rate of 6.89%. The most commonly consulted specialties were gynecology (18.94% of the overall referrals), ophthalmology (18.04%) and traumatology (16.10%). Psychiatry (1.41%), neurology (1.31%) and endocrinology (1.41%) were the specialties with the lowest referral rates. We compared our results with those from other authors and we have calculated what influence would be exerted on the second level of care if all primary care physicians had similar referral rates to those obtained in our center.