Appendiceal mucinous neoplasm, a rare diagnosis within gastrointestinal tumors. Case report.

Appendicular neoplasms are rare tumors, with an incidence of less than 0.05% among all gastrointestinal tumors. This work presents the case of a 52-year-old patient who manifested colicky pain in the right iliac fossa. Laboratory test results with bandemia and hyperbilirubinemia. Abdominal tomography with an acute appendicular inflammatory process, for which the patient was admitted for surgery. A dependent tumor of the cecum and appendicular region is observed, which compromises the ileocecal valve. The histopathological diagnosis was "low-grade appendiceal mucinous neoplasm." Appendiceal tumors are often incidental findings due to their low frequency; however, their possibility should not be dismissed.

Las neoplasias apendiculares son tumores raros, con una incidencia menor al 0.05% de todos los tumores gastrointestinales. Presentamos el caso de paciente de 52 años, quien acude por dolor cólico en fosa iliaca derecha. Estudios de laboratorio con bandemia e hiperbilirrubinemia. Tomografía abdominal con proceso inflamatorio apendicular agudo por lo que se ingresa a cirugía. Se observa tumoración dependiente de ciego y región apendicular que compromete válvula ileocecal. El diagnóstico histopatológico fue "neoplasia mucinosa apendicular de bajo grado. Los tumores de apéndice son a menudo hallazgos incidentales por su baja frecuencia, sin embargo, su posibilidad no debe descartarse.

Tumor de Brenner benigno asociado a tumor mucinoso borderline de ovario en paciente postmenopáusica / Benign Brenner tumour associated with a borderline mucinous tumour of the ovary in a post-menopausal patient

El tumor de Brenner es una neoplasia ovárica infrecuente de origen incierto, generalmente asintomática. Su diagnóstico es complejo, sin presentar patrones ecográficos específicos. Se ha asociado a tumores mucinosos con distinto potencial de malignidad, pudiendo encontrar componentes malignos o borderline que determinarán el tratamiento. Para su diagnóstico diferencial es esencial la realización de un estudio inmunohistoquímico, para objetivar el origen clonal del tumor de Brenner y de la estirpe mucinosa. Presentamos el caso de una mujer diagnosticada intraoperatoriamente de un tumor de Brenner asociado a un tumor mucinoso borderline de ovario, en el estudio definitivo posterior.(AU)

Brenner tumour is an uncommon neoplasm of the ovary of uncertain origin and often asymptomatic. Diagnostic is complex, without specific ultrasound patterns. It has been associated with mucinous tumours with different potential for malignancy, and it is possible to find malignant or borderline components that determine the treatment. For its differential diagnosis immunohistochemical study is essential, which shows, according to various studies, a clonal origin of Brenner and mucinous tumour. This is a case report of a Brenner tumour associated with a mucinous tumour, which in a definitive study showed to be associated with a borderline ovarian tumour component.(AU)

Cystic neoplasm of the appendix. Report of an unusual clinical case at the South Central High Specialty Hospital PEMEX.

Las neoplasias del apéndice son un grupo heterogéneo de tumores con una incidencia baja, la presentación clínica es inespecífica, cursando generalmente de forma asintomática, y la tomografía es el estudio de elección para el diagnóstico. El tratamiento dependerá del tipo histológico del tumor.The appendix neoplasms are a heterogeneous group of tumors with a low incidence, the clinical presentation is nonspecific, usually being asymptomatic, tomography is the study of choice for the diagnosis. Treatment will depend on the histological type of the tumor.

Tumor ovárico benigno proliferante mucinoso de tipo endocervical con hiperplasia microglandular / Benign mucinous endocervical type ovarian tumor with microglandular hyperplasia

Resumen Antecedentes La aparición más común de la hiperplasia micro-glandular es en el endocérvix, luego en sitios con epitelio glandular mucinoso; en el ovario es excepcional. Se ha descrito posterior a la exposición a la progesterona como anticonceptivo, sin antecedente de exposición hormonal y en mujeres posmenopáusicas. En 2014 la OMS clasificó los tumores mucinosos de ovario como: mucinosos fronterizos (borderline), seromucinosos fronterizos (tumores mucinosos de tipo endocervical-mülleriano) y carcinoma mucinoso. Objetivo Exponer el diagnóstico de una tumoración ovárica benigna infrecuente, en una paciente que recibió estimulación hormonal con fines reproductivos. Caso clínico Paciente de 38 años, con hallazgo ecográfico de formación quística de 25 x 33 mm de pared gruesa e irregular, con papila de 6 mm vascularizada y el resto de contenido quístico heterogéneo. La paciente había recibido hiperestimulación ovárica controlada en cuatro ocasiones, la última seis meses previos al hallazgo, momento en que recibía anticoncepción combinada, previa a un nuevo ciclo. Se le practicó anexectomía derecha y lavado peritoneal. El diagnóstico anatomopatológico fue de tumor mucinoso proliferante, de tipo endocervical, con hiperplasia microglandular y citología del líquido aspirado, inflamatoria. El perfil inmunohistoquímico fue: citoqueratina7 positiva y citoqueratina 20, CDX2 (proteína homeobox) y antígeno carcinoembrionario negativos. El anticuerpo monoclonal Ki-67 fue menor de 10%. Los receptores de estrógenos fueron focalmente positivos y los de progesterona positivos de forma difusa e intensa. La paciente evolucionó favorablemente después del tratamiento. Conclusiones La hiperplasia microglandular puede aparecer en tumores mucinosos benignos de ovario y hay que considerar su posible implicación hormonal.

Abstract Background Microglandular hyperplasia is most commonly located in the endocervix, but may appear in any location with mucinous glandular epithelium. Ovarian presentation is exceptional. It has been described in women after exposure to progesterone as contraceptive, without history of hormonal exposure and in postmenopausal. In 2014, WHO classified mucinous ovarian tumors as borderline mucinous, borderline seromucinous (mucinous tumors of the endocervical/mül-lerian type) and mucinous carcinoma. Objective To describe the diagnosis of an uncommon benign ovarian tumor in a patient who underwent hormonal stimulation for reproductive purposes. Clinical case 38-year-old patient with an ultrasound finding of a 25 x 33mm cystic formation with a thick and irregular wall, a 6mm vascularized papilla and a heterogeneous cystic content. The patient had undergone controlled ovarian hyperstimulation on four occasions, the last one 6 months prior to the finding, when she was on combined contraception prior to a new cycle. Right adnexectomy and peritoneal lavage were performed. The anatomopathological diagnosis was an endocervical mucinous proliferative tumor with microglan-dular hyperplasia and inflammatory cytology of the aspirated fluid. The immunohistochemical profile was: cytokeratin 7 positive and cytokeratin 20, CDX2 (homeobox protein) and CEA (carcinoembry-onic antigen) negative. The monoclonal antibody Ki-67 was < 10%. Estrogen receptors were focally positive and progesterone receptors positive in a diffuse and intense form. After treatment, the patient had a favorable evolution. Conclusions Microglandular hyperplasia may be present in ovarian mucinous benign tumors. A hormonal involvement should be considered.

Cistoadenoma mucinoso gigante de ovario de bajo grado de malignidad / Giant mucinous ovarian cystadenoma of low malignancy

El cistoadenoma mucinoso de ovario representa aproximadamente 15 por ciento de las lesiones neoplásicas benignas de ovario y en 5 por ciento de los casos pueden ser bilaterales. Suele manifestarse en edades medias de la vida y son poco frecuentes en la edad pediátrica y en la adolescencia. El objetivo del trabajo es profundizar en el diagnóstico y la conducta terapéutica de esta enfermedad. Se realizó una revisión del tema y se presentó un caso relevante por las dimensiones del quiste. Se presenta una adolescente de 16 años de edad que presentó un cuadro de distensión abdominal y dolor en hemiabdomen derecho de un mes de evolución. Se le realizó cirugía y se encontró un tumor gigante de ovario izquierdo con 10 kilogramos de peso, se corroboró el diagnóstico histológico de cistoadenoma mucinoso de ovario. La paciente evolucionó satisfactoriamente(AU)

Ovarian mucinous cystadenoma accounts for approximately 15 percent of benign ovarian neoplastic lesions and in 5 percent of cases may be bilateral. It usually manifests in middle ages of life and they are rare in pediatric age and adolescence. The objective of this paper work is to deepen on the diagnosis and therapeutic state of this disease. A review of the topic was made and a case was presented because of the significant dimensions of the cyst. We present a 16-year-old girl who presented abdominal distension and pain in the right hemiabdomen for a month of evolution. Surgery was performed and a giant tumor on the left ovary was found. It weighed 10 kilograms, corroborating the histological diagnosis of mucinous ovarian cystadenoma. The patient evolved satisfactorily(AU)

Cistoadenoma mucinoso gigante de ovario de bajo grado de malignidad / Giant mucinous ovarian cystadenoma of low malignancy

El cistoadenoma mucinoso de ovario representa aproximadamente 15 % de las lesiones neoplásicas benignas de ovario y en 5 % de los casos pueden ser bilaterales. Suele manifestarse en edades medias de la vida y son poco frecuentes en la edad pediátrica y en la adolescencia. El objetivo del trabajo es profundizar en el diagnóstico y la conducta terapéutica de esta enfermedad. Se realizó una revisión del tema y se presentó un caso relevante por las dimensiones del quiste. Se presenta una adolescente de 16 años de edad que presentó un cuadro de distensión abdominal y dolor en hemiabdomen derecho de un mes de evolución. Se le realizó cirugía y se encontró un tumor gigante de ovario izquierdo con 10 kilogramos de peso, se corroboró el diagnóstico histológico de cistoadenoma mucinoso de ovario. La paciente evolucionó satisfactoriamente.

Ovarian mucinous cystadenoma accounts for approximately 15 % of benign ovarian neoplastic lesions and in 5 % of cases may be bilateral. It usually manifests in middle ages of life and they are rare in pediatric age and adolescence. The objective of this paper work is to deepen on the diagnosis and therapeutic state of this disease. A review of the topic was made and a case was presented because of the significant dimensions of the cyst. We present a 16-year-old girl who presented abdominal distension and pain in the right hemiabdomen for a month of evolution. Surgery was performed and a giant tumor on the left ovary was found. It weighed 10 kilograms, corroborating the histological diagnosis of mucinous ovarian cystadenoma. The patient evolved satisfactorily.

Mucinous appendiceal neoplasms: Incidence, diagnosis and surgical treatment. / Tumores mucinosos del apéndice: incidencia, diagnóstico y tratamiento quirúrgico.

INTRODUCTION: Mucinous tumors of the appendix are a rare pathology, with a prevalence below 0.5%. Clinical presentation usually occurs during the sixth decade of life, and mucinous tumors can clinically mimic acute appendicitis. The aim of this study is to describe the clinical and demographic variables, therapeutic procedure and diagnosis of these tumors. We analyze the association between mucinous tumors and pseudomyxoma peritonei (PP), as well as the association with colorectal and ovarian tumors. METHODS: A retrospective study was performed including patients who underwent an appendectomy between December 2003 and December 2014. RESULTS: Seventy-two mucinous tumors of the appendix were identified among 7.717 patients reviewed, resulting in a prevalence of 0.9%. Mean age at presentation was 64 years, 62% patients were female and 38% males. An incidental diagnosis was made in 43% of patients. Mucinous tumors of low malignant potential were significantly related to the presence of pseudomyxoma peritonei, identified in 16 (22%) of the cases. We also observed an increased risk of ovarian mucinous tumors in patients with a diagnosis of appendiceal mucinous neoplasm. In our sample, 22 (30.5%) patients showed a synchronous or metachronous colorectal cancer. CONCLUSIONS: Appendiceal mucinous tumors are frequently an incidental finding. The diagnosis of mucinous tumors of low malignant potential is a factor associated with the development of pseudomyxoma peritonei. Histologic tumor grade and the presence of peritoneal dissemination will determine surgical treatment that can vary, from appendectomy to cytoreductive surgery.

Latest advances in pancreatic tumours. / Últimos avances sobre los tumores pancreáticos.

Pancreatic cancer continues to have a bleak prognosis. Hardly any therapeutic advances have been made in the last few years and consequently most efforts have focused on preventing its development and on diagnosing precursor lesions. In this regard, the use of statins as a preventive factor and the implementation of screening programmes in high-risk patients are gaining ground. In the field of treatment, there is greater focus on the role of neoadjuvant therapy in pancreatic cancer and on a multimodal approach to the disease, with few advances in effective novel therapies. Most studies concerned cystic tumours of the pancreas, especially intraductal mucinous papillary tumour, with its known potential for malignant transformation. Multiple studies were devoted to validation of the 2012 Fukuoka international guidelines and the highly controversial 2015 AGA guidelines. Notable among these studies were those demonstrating the suboptimal positive predictive value and questioning important aspects of the guidelines, such as discontinuation of follow-up or the criteria for surgical referral. Notable among diagnostic procedures were cystoscopy and endoscopic ultrasound-guided needle-based confocal laser endomicroscopy as the most promising techniques due to their high efficacy and negative predictive value in detecting mucinous cystic lesions. There were also a large number of studies on the natural history of intraductal papillary mucinous tumours, which help deepen knowledge of these entities and the search for predictive factors of cancer development.

[Latest advances in pancreatic tumours]. / Últimos avances en tumores pancreáticos.

Pancreatic cancer continues to have an extremely poor prognosis. There have been hardly any therapeutic advances in the last few years and consequently attention is focussed on early diagnosis. In this regard, endoscopic ultrasonography and several associated techniques, such as electrography or the use of intravenous contrast agents, continue to be the cornerstone of differential diagnosis. In the latest Digestive Diseases Week, numerous presentations were made on cystic pancreatic tumours, especially intraductal papillary mucinous tumours, with their well-known potential for malignant transformation. In addition to the problems of the preoperative characterization of these entities, by both endoscopic ultrasound cytological evaluation--even with the presence of an on-site pathologist--and by intracystic markers, the role of other techniques was also mentioned, such as confocal laser endomicroscopy or the use of intravenous contrast agents to characterize the wall nodule. There were numerous studies on the natural history of intraductal papillary mucinous tumours, which mainly supported the increasingly conservative approach adopted by the recent Fukuoka international guidelines. Certain aspects were highlighted, such as comorbidities, when considering surgery, or the growth rate of the tumour. In treatment, endoscopic ultrasound-guided injection of gemcitabine and paclitaxel, without the need for alcohol as an ablative treatment of mucinous cystic tumours, is gaining ground in specific cases.

Tumor mucinoso gigante de ovario de bajo grado de malignidad / Giant Mucinous Ovarian Tumor of Low Malignant Potential

Los tumores de ovario de bajo grado de malignidad o "borderline", se originan del epitelio de este órgano y tienen un comportamiento biológico intermedio entre las lesiones malignas y benignas del ovario. El estudio se realizó con el objetivo de profundizar en el diagnóstico y la conducta terapéutica de esta infrecuente afección nosológica. Se presenta un caso clínico atendido en el servicio de Cirugía General del Hospital General Docente "Leopoldito Martínez", en San José de las Lajas, provincia Mayabeque. No se identificaron signos patológicos. Se identificó vulva y vagina sin alteraciones. El diagnóstico se estableció por el examen histopatológico y el tratamiento quirúrgico fue radical...

Ovarian tumors of low malignant potential or "borderline" originate from the epithelium of this body and they have an intermediate biological behavior between malignant and benign ovarian lesions. This study aims to deepen the diagnosis and therapeutic management of this uncommon nosological condition. A clinical case is presented here. This patient was treated at the Department of General Surgery, at Leopoldito Martinez General Teaching Hospital in San José de las Lajas, Mayabeque province. No pathological signs were identified. Vulva and vagina had no alterations. The diagnosis was established by histopathological examination and surgical treatment was radical...

Tumor mucinoso gigante de ovario de bajo grado de malignidad / Giant Mucinous Ovarian Tumor of Low Malignant Potential

Los tumores de ovario de bajo grado de malignidad o borderline, se originan del epitelio de este órgano y tienen un comportamiento biológico intermedio entre las lesiones malignas y benignas del ovario. El estudio se realizó con el objetivo de profundizar en el diagnóstico y la conducta terapéutica de esta infrecuente afección nosológica. Se presenta un caso clínico atendido en el servicio de Cirugía General del Hospital General Docente Leopoldito Martínez, en San José de las Lajas, provincia Mayabeque. No se identificaron signos patológicos. Se identificó vulva y vagina sin alteraciones. El diagnóstico se estableció por el examen histopatológico y el tratamiento quirúrgico fue radical(AU)

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Ovarian tumors of low malignant potential or borderline originate from the epithelium of this body and they have an intermediate biological behavior between malignant and benign ovarian lesions. This study aims to deepen the diagnosis and therapeutic management of this uncommon nosological condition. A clinical case is presented here. This patient was treated at the Department of General Surgery, at Leopoldito Martinez General Teaching Hospital in San José de las Lajas, Mayabeque province. No pathological signs were identified. Vulva and vagina had no alterations. The diagnosis was established by histopathological examination and surgical treatment was radical(AU)

[Pancreatic tumors: recent developments]. / Últimos avances sobre los tumores pancreáticos.

Pancreatic cancer (PC) still typically has a poor prognosis. In addition to smoking, obesity and new-onset diabetes mellitus are considered to be significant risk factors. An endoscopic ultrasound (EUS) remains the mainstay for diagnosis and on which the majority of advances are based. In this sense, needle-based confocal laser endomicroscopy (nCLE) is gaining importance in the differential diagnosis of solid pancreatic lesions and studies comparing different needle types (cytology vs. histology) for EUS-guided puncture. Intravenous contrast (IC-EUS) and elastography are additional tools associated with EUS that can assist in diagnosing PC. Regarding prognostic factors, the importance of the role of mesenteric-portal vein resection was emphasized, given the limited advances in treatment, as in previous years. Regarding cystic tumors, work focuses on validating the new international guidelines from Fukuoka 2012 (revised Sendai criteria) and on determining predictors of cystic lesion malignancy, mainly of intraductal papillary mucinous neoplasm (IPMN). From a therapeutic point of view, there are theories regarding the usefulness of alcohol and the gemcitabine-paclitaxel combination in the ablation of small mucinous cystic lesions through EUS-injection.

Tumores mucinosos del páncreas / Mucinous tumors of the pancreas

Los tumores mucinosos del páncreas son lesiones premalignas que cursan casi siempre de forma asintomática y la mayoría de las veces se realiza su detección de forma incidental. Tanto el diagnóstico como la conducta terapéutica constituyen un reto para las diferentes especialidades involucradas en el manejo de estas lesiones, dadas las diferencias en la historia natural del espectro de las lesiones: benignas, malignas y borderline; de ahí la importancia de los esfuerzos por lograr consensuar criterios en aras de un mejor seguimiento. Interesados por estos elementos se decide realizar esta revisión bibliográfica de los tumores mucinosos del páncreas e identificar los criterios para el diagnóstico y la conducta a seguir. Para lograr este objetivo se revisó la bibliografía más actualizada consultando revistas digitales, impresas y temas obtenidos de diferentes sitios Web, incluyendo la guía del consenso internacional para el manejo de los tumores mucinosos pancreáticos (AU)

Mucinous tumors of the pancreas are premalignant lesions that occur almost always asymptomatic and most of the time they are detected incidentally. Both the diagnosis and therapeutic behavior constitute a challenge for the different specialties involved in the management of these lesions, given the differences in the natural history of the spectrum of lesions: benign, malignant and borderline; hence the importance of efforts to achieve consensus criteria in order to better monitoring. The authors were interested in these items, so it was decided to conduct this bibliographic review on mucinous tumors of the pancreas and to identify the criteria for diagnosis and behavior to follow. To achieve this goal the most updated bibliography was reviewed, it was consulted digital journals, printed ones and themes obtained from different Web sites, including the international consensus guidelines for management of pancreatic mucinous tumors (AU)

[Latest advances in pancreatic tumors]. / Últimos avances sobre los tumores pancreáticos.

Pancreatic cancer (PC) continues to have a very poor prognosis. New epidemiological trials suggest that statins could play a protective role in smokers, while HbsAg-positive hepatitis B virus could be a risk factor. Endoscopic ultrasound (EUS) is the main diagnostic tool for PC, and new technologies associated with this technique have emerged, such as quantitative elastography, intravenous contrasts or, more recently, LASER confocal endomicroscopy. New markers in urine or pancreatic juice have appeared to distinguish between PC and chronic pancreatitis. The role of the "on site" cytopathologist to increase the diagnostic yield of EUS-guided pancreatic sampling is completely supported by new prospective trials and some multicenter studies have been reported that compare the standard cytologic needles with the new procore-histology needles. Regarding cystic pancreatic tumors, most studies have aimed to validate the 2012 Sendai international guidelines and to ascertain predictive factors of malignancy in cystic lesions, mainly intraductal papillary mucinous neoplasm (IPMN). The role of intracystic CEA levels in determining malignancy is challenged. From a therapeutic point of view, EUS-guided radiofrequency ablation of cystic and solid lesions has emerged as a feasible and safe procedure in specific circumstances.