RESUMEN
Reportamos el caso de un paciente masculino, 80 años, con historia de dispepsia y sin antecedente familiar de neoplasias. En la endoscopia digestiva alta, en tercio distal, se observó una lesión deprimida plana con aspecto de carcinoma precoz IIC que fue diagnosticada por biopsia como carcinoma escamoso in situ e infiltrante, no queratinizante moderadamente diferenciado grado II. Fue sometido a disección endoscópica submucosa, sin complicaciones. La histopatología concluyo: carcinoma de células escamosas, predominantemente in situ de esófago distal, midiendo 0,6 cm, con foco de 0,1 cm de infiltración en la lámina propia; ausencia de invasión neoplásica angiolinfática o perineural con márgenes de resección quirúrgica libre de neoplasia. Estadio pT1a. Tres meses después, en la endoscopia de control con toma de biopsias de la zona, no hubo evidencia de carcinoma. Presentamos el caso debido a que sigue siendo todo un reto establecer el diagnóstico de cáncer de esófago en etapa temprana, sobre todo en pacientes poco sintomáticos, resaltando la importancia de la cromoendoscopia y de una buena exploración endoscópica para llegar al diagnóstico. La disección endoscopia submucosa podría considerarse como un tratamiento alternativo seguro y eficaz a la cirugía radical.
We report the case of a male patient, 80 years old, with a history of dyspepsia and no family history of neoplasias. In the upper digestive endoscopy in the distal esophagus, a flat depressed lesion with the appearance of early carcinoma, type IIC of Paris classification, was diagnosed by biopsy as a squamous carcinoma in situ, infiltrating, moderately differentiated non-keratinizing grade II carcinoma. He underwent submucosal endoscopic dissection without complications. Histopathology concluded: carcinoma of squamous cells, predominantly in situ of distal esophagus, measuring 0.6 cm, with focus of 0.1 cm of infiltration in the own lamina; absence of angiolymphatic or perineural invasion. The histopathology specimen had margins of surgical resection free of neoplasia. Stage pT1a. Three months later, in the endoscopy control with biopsy of the area, there was no evidence of carcinoma. We present the case because it is still a challenge to establish the diagnosis of esophageal cancer at an early stage, especially in patients without symptoms, highlighting the importance of chromoendoscopy and a good endoscopic examination to reach the diagnosis. Submucosal endoscopy dissection could be considered as a safe and effective alternative treatment to radical surgery.
Asunto(s)
Anciano de 80 o más Años , Humanos , Masculino , Neoplasias Esofágicas/cirugía , Carcinoma in Situ/cirugía , Carcinoma de Células Escamosas/cirugía , Detección Precoz del Cáncer , Inducción de Remisión , Neoplasias Esofágicas/diagnóstico , Carcinoma in Situ/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Diferenciación Celular , Esofagoscopía , Disección/métodosRESUMEN
We report the case of a male patient, 80 years old, with a history of dyspepsia and no family history of neoplasias. In the upper digestive endoscopy in the distal esophagus, a flat depressed lesion with the appearance of early carcinoma, type IIC of Paris classification, was diagnosed by biopsy as a squamous carcinoma in situ, infiltrating, moderately differentiated non-keratinizing grade II carcinoma. He underwent submucosal endoscopic dissection without complications. Histopathology concluded: carcinoma of squamous cells, predominantly in situ of distal esophagus, measuring 0.6 cm, with focus of 0.1 cm of infiltration in the own lamina; absence of angiolymphatic or perineural invasion. The histopathology specimen had margins of surgical resection free of neoplasia. Stage pT1a. Three months later, in the endoscopy control with biopsy of the area, there was no evidence of carcinoma. We present the case because it is still a challenge to establish the diagnosis of esophageal cancer at an early stage, especially in patients without symptoms, highlighting the importance of chromoendoscopy and a good endoscopic examination to reach the diagnosis. Submucosal endoscopy dissection could be considered as a safe and effective alternative treatment to radical surgery.
Asunto(s)
Carcinoma in Situ/cirugía , Carcinoma de Células Escamosas/cirugía , Detección Precoz del Cáncer , Neoplasias Esofágicas/cirugía , Anciano de 80 o más Años , Carcinoma in Situ/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Diferenciación Celular , Disección/métodos , Neoplasias Esofágicas/diagnóstico , Esofagoscopía , Humanos , Masculino , Inducción de RemisiónRESUMEN
Carcinoid tumors belong to the families of neuroendocrine tumors. The major sites are the gastrointestinal tract 65% and lungs 25%. The small intestine, specifically the ileum, is the most common. These tumors although rare, are more common in tumors of neuroendocrine origin gastro-entero-pancreatic. In both cases we observe the different clinical presentations that may have carcinoid tumor; in case 1 ulceration of the tumor mass causing the elimination of melena, and severe diarrhea caused by neuroendocrine secretion. Case 2 typical course, totally asymptomatic incidental finding.