RESUMEN
El leiomiosarcoma es un raro tumor primario en el pene. Presentamos el caso de un varón de 78 años que empieza a manifestarse con uretrorragia y tumor perineal. El estudio histopatológico demuestra un tumor de uretra bulbar con fenotipo muscular liso maligno, inmunofenotipo compatible con origen muscular liso y estudio ultraestructural con morfología mesenquimal. Es un tumor de alto grado de malignidad por su morfología y evolución, no habiéndose constatado su existencia en una cistoscopia realizada seis meses antes. El principal diagnóstico diferencial se establece con tumores fusocelulares malignos. El tratamiento agresivo no ha logrado ser eficaz (AU)
Asunto(s)
Anciano , Masculino , Humanos , Cistoscopía/métodos , Cistoscopía , Tomografía Computarizada de Emisión/métodos , Inmunohistoquímica/métodos , Leiomiosarcoma/complicaciones , Leiomiosarcoma/diagnóstico , Leiomiosarcoma/etiología , Leiomiosarcoma/cirugía , Leiomiosarcoma/ultraestructura , Neoplasias del Pene/cirugía , Neoplasias del Pene/diagnóstico , Neoplasias del Pene/etiología , Neoplasias Primarias Desconocidas/complicaciones , Neoplasias Primarias Desconocidas/diagnóstico , Perineo/cirugía , Perineo/patología , Diagnóstico Diferencial , Carcinoma/complicaciones , Carcinoma/diagnóstico , Carcinoma/etiología , Carcinoma/fisiopatología , Carcinoma/ultraestructura , Factores Sexuales , Neoplasias Uretrales/complicaciones , Neoplasias Uretrales/diagnóstico , Neoplasias Uretrales/patologíaRESUMEN
We report a patient in whom sarcoidosis coexisted with sclerosing cholangitis and chronic atrophic autoimmune gastritis. There are some autoimmune diseases associated with primary sclerosing cholangitis; the difference between sarcoidosis and all other autoimmune diseases associated with primary sclerosing cholangitis is the ability of the former to damage the biliary tree. Moreover, when sarcoidosis behaves like cholestasis it can damage the biliary tree, mimicking primary sclerosing cholangitis, with high immunoglobulin M but without inflammatory bowel disease and p-ANCAs negative. We believe that it should be regarded as a single disease "infiltrative sclerosing cholangitis" because this is not a primary disease and sarcoidosis would be responsible for a beaded biliary tree.
Asunto(s)
Enfermedades Autoinmunes/complicaciones , Colangitis Esclerosante/complicaciones , Gastritis Atrófica/complicaciones , Sarcoidosis/complicaciones , Adulto , Enfermedades Autoinmunes/diagnóstico por imagen , Enfermedades Autoinmunes/inmunología , Colangitis Esclerosante/diagnóstico por imagen , Colangitis Esclerosante/inmunología , Diagnóstico Diferencial , Gastritis Atrófica/diagnóstico por imagen , Gastritis Atrófica/inmunología , Conducto Hepático Común/diagnóstico por imagen , Humanos , Inmunoglobulina M/sangre , Cirrosis Hepática Biliar/complicaciones , Cirrosis Hepática Biliar/diagnóstico por imagen , Cirrosis Hepática Biliar/inmunología , Masculino , Radiografía , Sarcoidosis/diagnóstico por imagen , Sarcoidosis/inmunología , Sarcoidosis Pulmonar/complicaciones , Sarcoidosis Pulmonar/diagnóstico por imagen , Sarcoidosis Pulmonar/inmunologíaRESUMEN
BACKGROUND: To know the influence of upper gastrointestinal bleeding in diagnostic methods of H. pylori infection. METHODS: We prospectively studied patients with peptic ulcers: 55 with upper gastrointestinal bleeding and 62 without upper gastrointestinal bleeding. We analysed the results of culture, urease test, Gram, histology and serological test IgG and IgA in both groups. H. pylori infection was determined by a positive culture or positive urease test and histology. RESULTS: Patients with upper gastrointestinal bleeding were older, but there were not statistical differences in sex, H. pylori prevalence infection or duodenal or gastric ulcers between patients with and without upper gastrointestinal bleeding. 78% having H. pylori infection. The urease test had a false negative rate in patients with upper gastrointestinal bleeding of 22% but only 3% in patients without upper gastrointestinal bleeding (p < 0.05). The culture, histology and Gram had higher false negative rate in upper gastrointestinal bleeding group than in non upper gastrointestinal bleeding group but without statistical significance. All patients with false negative urease test had antral culture positive. CONCLUSIONS: Urease test has a high false negative rate when is studied in patients with peptic ulcers and upper gastrointestinal bleeding. Caution should be made if urease test was used alone for diagnosis in patients with upper gastrointestinal bleeding. Urease test and culture together could be a good diagnostic method.