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The aim of this study was to describe clinical and survival characteristics of transplant-eligible multiple myeloma (MM) patients in Latin America (LA), with a special focus on differences between public and private healthcare facilities. We included 1293 patients diagnosed between 2010 and 2018. A great disparity in outcomes and survival between both groups was observed. Late diagnosis and low access to adequate frontline therapy and ASCT in public institutions probably explain these differences. Patients treated with novel drug induction protocols, followed by autologous stem cell transplantation (ASCT) and maintenance, have similar overall survival compared to that published internationally.

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INTRODUCTION: Inverted papilloma is a locally-aggressive benign neoplasm of the paranasal sinuses with a high potential for recurrence and malignancy. Intracranial extension is infrequent, and dural penetration even more so, typically associated with recurrence of the disease or its degeneration into squamous cell carcinoma. CLINICAL CASE: A 32-year-old female patient consulted us for an exophytic lesion in her right nostril and exophthalmos, associated with headache, anosmia and dysgeusia. Craniofacial and brain CT and brain MRI demonstrated a lesion in the right nostril, extending into the aerial sinuses, orbital lateral wall and anterior fossa, with osteolysis and intracranial invasion towards the right frontal region. A mass effect and brain compression were noted. A histological diagnosis of inverted papilloma was made initially. Upon later resection of the lesion by double access, with reconstruction of the anterior cranial fossa, a definitive diagnosis was made of inverted papilloma of the Schneiderian type, with areas of atypical transformation in situ. Post-operatively, the patient has had a favorable course, with full upper airway patency and neither complications nor signs of recurrence after four years of follow-up. CONCLUSIONS: Intracranial invasion of this pathology is extremely uncommon. When it exists, the tumor has a high potential for local recurrence. Consequently, complete excision of the lesion determines the patient's prognosis.

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Objetivo. Presentar un caso de esta infrecuente patología; realizar una revisión bibliográfica y analizar su etiología, características clínicas y tratamiento. Descripción. Paciente femenina de 60 años de edad, que consultó por presentar hemiparesia braquiocrural derecha y afasia de expresión de 30 días de evolución. La TAC y RMN evidenciaron lesiones localizadas a nivel parieto-occipital izquierda, parainsular y occipital derecha. El screening oncológico fue negativo. Intervención. Se realizó craniotomía y exéresis subtotal de la lesión parieto-occipital izquierda. La anatomía patológica informó gliosarcoma. Completó tratamiento con radioterapia holocraneana y quimioterapia con temozolamida. La paciente falleció a los diez meses del diagnóstico.(AU)

Objetive. We report a rare case of Multicentric Gliosarcoma, we review the literature and analyze its causes, clinical features and treatment.Description. Sixty-year-old female patient who has presented right hemiparesis and motor aphasia for a month. CT and MRI showed lesions at the left parieto-occipital lobes, right occipital and parainsular lobes. Oncologic screening was negative.Intervention. A craniotomy and subtotal excision of parietooccipital lesion was performed. Histological examination revealed gliosarcoma. She received radiotherapy and chemotherapy,however she died ten months after the diagnosis. Conclusion. Multicentric gliosarcoma is very unfrequent. Thereare only two cases reported in the literature. Even so, it must besuspected in multiple cerebral lesions.(AU)

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Objetivo. Presentar un caso de esta infrecuente patología; realizar una revisión bibliográfica y analizar su etiología, características clínicas y tratamiento. Descripción. Paciente femenina de 60 años de edad, que consultó por presentar hemiparesia braquiocrural derecha y afasia de expresión de 30 días de evolución. La TAC y RMN evidenciaron lesiones localizadas a nivel parieto-occipital izquierda, parainsular y occipital derecha. El screening oncológico fue negativo. Intervención. Se realizó craniotomía y exéresis subtotal de la lesión parieto-occipital izquierda. La anatomía patológica informó gliosarcoma. Completó tratamiento con radioterapia holocraneana y quimioterapia con temozolamida. La paciente falleció a los diez meses del diagnóstico.

Objetive. We report a rare case of Multicentric Gliosarcoma, we review the literature and analyze its causes, clinical features and treatment.Description. Sixty-year-old female patient who has presented right hemiparesis and motor aphasia for a month. CT and MRI showed lesions at the left parieto-occipital lobes, right occipital and parainsular lobes. Oncologic screening was negative.Intervention. A craniotomy and subtotal excision of parietooccipital lesion was performed. Histological examination revealed gliosarcoma. She received radiotherapy and chemotherapy,however she died ten months after the diagnosis. Conclusion. Multicentric gliosarcoma is very unfrequent. Thereare only two cases reported in the literature. Even so, it must besuspected in multiple cerebral lesions.

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Objective: To present two cases of leptomeningeal carcinomatosis, their management, and a bibliographical revision. Description: case 1: patient of 48 years, who enters by sensory abnormalities, with CT that demotrated tetraventricular hydrocephalus. The CSF was positive for neoplasic cells. Primary tumor was found in bladder. Case 2: patient of 55 years, who entered by progressive cuadriparesia. He presented sensory abnormalities by acute hydrocephalus. The autopsy informed meningeal affectation by gastric carcinoma. Discussion: Although patognomonic signs do not exist, the more frequent clinical manifestations are affectation of cranial nerves, headache and alterations of the mental functions. The RNM with gadolinium is the best method, with a sensitivity of 70. In the infrequent cases of acute hydrocephalus, the CT is the first study to perform. Conclusion: Before the unspecific signs, the diagnosis of certainty of meningeal carcinomatosis is based on the help of radiological investigations and the findings of the LCR, on an oncologic context.

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