RESUMEN
The development of a cancer of the esophagus in women who previously had received radiotherapy for breast cancer is a known although infrequent event. The risk of apparition of the second neoplasia is greater in women who survive at least ten years after the exposition to the radiation. Squamous cell carcinoma is the histological subtype more frequent. We report a case of adenocarcinoma of the esophagus in a man diagnosed of benign symmetrical lipomatosis (Madelung' disease), who had received adjuvant radiotherapy three years before for breast cancer.
Asunto(s)
Adenocarcinoma/complicaciones , Neoplasias de la Mama Masculina/complicaciones , Carcinoma Ductal de Mama/complicaciones , Neoplasias Esofágicas/complicaciones , Lipomatosis Simétrica Múltiple/complicaciones , Neoplasias Inducidas por Radiación/etiología , Neoplasias Primarias Secundarias/etiología , Radioterapia Adyuvante/efectos adversos , Anciano , Consumo de Bebidas Alcohólicas/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Esófago de Barrett/complicaciones , Neoplasias de la Mama Masculina/tratamiento farmacológico , Neoplasias de la Mama Masculina/radioterapia , Neoplasias de la Mama Masculina/cirugía , Carcinoma Ductal de Mama/tratamiento farmacológico , Carcinoma Ductal de Mama/radioterapia , Carcinoma Ductal de Mama/cirugía , Quimioterapia Adyuvante , Terapia Combinada , Trastornos de Deglución/etiología , Resultado Fatal , Hematemesis/etiología , Humanos , Escisión del Ganglio Linfático , Masculino , Mastectomía Radical Modificada , Factores de Riesgo , Fumar/efectos adversosRESUMEN
No disponible
Asunto(s)
Femenino , Adulto , Humanos , Hamartoma/diagnóstico , Enfermedades de los Conductos Biliares/diagnósticoRESUMEN
La aparición de un cáncer de esófago en mujeres que previamente han recibido radioterapia como tratamiento de un cáncer de mama es un hecho conocido aunque poco frecuente. El riesgo de aparición de la segunda neoplasia es mayor cuando han transcurrido diez o más años desde la exposición a la radiación. La estirpe histológica de la neoplasia de esófago más frecuente es la de carcinoma de células escamosas. Se presenta un caso de adenocarcinoma de esófago en un varón, diagnosticado de lipomatosis bilateral simétrica o enfermedad de Madelung, que recibió radioterapia tres años antes por presentar un cáncer de mama
The development of a cancer of the esophagus in women who previously had received radiotherapy for breast cancer is a known although infrequent event. The risk of apparition of the second neoplasia is greater in women who survive at least ten years after the exposition to the radiation. Squamous cell carcinoma is the histological subtype more frequent. We report a case of adenocarcinoma of the esophagus in a man diagnosed of benign symmetrical lipomatosis (Madelung disease), who had received adjuvant radiotherapy three years before for breast cancer
Asunto(s)
Masculino , Anciano , Humanos , Adenocarcinoma/complicaciones , Carcinoma Ductal de Mama/complicaciones , Lipomatosis Simétrica Múltiple/complicaciones , Radioterapia Adyuvante/efectos adversos , Neoplasias de la Mama Masculina/complicaciones , Neoplasias Inducidas por Radiación/etiología , Consumo de Bebidas Alcohólicas/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Esófago de Barrett/complicaciones , Carcinoma Ductal de Mama/tratamiento farmacológico , Carcinoma Ductal de Mama , Carcinoma Ductal de Mama/cirugía , Quimioterapia Adyuvante , Trastornos de Deglución/etiología , Resultado Fatal , Escisión del Ganglio Linfático , Factores de Riesgo , Neoplasias de la Mama Masculina/tratamiento farmacológico , Neoplasias de la Mama Masculina , Neoplasias de la Mama Masculina/cirugíaRESUMEN
OBJECTIVE: Needle-knife sphincterotomy (NKS) is used to achieve biliary access when routine cannulation methods have been unsuccessful. The aim of this study was to analyze the results of NNS in patients with an inaccessible common bile duct (difficult cannulation) using standard techniques in endoscopic retrograde cholangiopancreatography and the factors associated with the success of this procedure and complications. MATERIAL AND METHODS: We performed a prospective study of 72 patients who underwent NKS performed by the same endoscopist (J.E.) because of difficult cannulation of the common bile duct between January 1998 and December 2004. The results were analyzed in terms of successful biliary access, whether this was achieved in one or more sessions, its possible association with the underlying disease, and the incidence and severity of complications. RESULTS: Seventy-two NKS were performed from a total of 1062 sphincterotomies (6.7%). A total of 77.7% of the patients underwent prior implantation of a pancreatic prosthesis (NKS-PP). The final diagnosis was: choledocholithiasis (31.9%), cancer of the pancreas (16.6%), cholangiocarcinoma (13.8%), benign stenosis (8.3%), dysfunction of the sphincter of Oddi (6.9%), normal (6.9%), and miscellaneous (13.8%). Cannulation was successful in 87.5% (63/72), and was achieved in the first session in 73% (46/63). Biliary access was achieved in 72.7% of patients (16/22) with biliopancreatic neoplasms versus 94% (47/50) of those with other diagnoses (p = 0.03). Eleven patients (15.2%) presented 12 complications (16.6%) (6 pancreatitis, 4 cholangitis, 1 papillary hemorrhage, and 1 portal vein filling). The use of a pancreatic prosthesis was related to a higher success rate and significantly fewer complications (p = 0.03). CONCLUSIONS: NKS-PP can be a safe procedure in patients with difficult cannulation of the common bile duct. The presence of biliopancreatic neoplasm is a risk factor for failure to achieve biliary access compared with other diagnoses. The complication rate was similar to that found in other studies. No cases of severe pancreatitis or perforations were found.
Asunto(s)
Endoscopios , Esfinterotomía Endoscópica/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Ampolla Hepatopancreática/lesiones , Colangiocarcinoma/diagnóstico , Colangitis/etiología , Coledocolitiasis/diagnóstico , Neoplasias del Conducto Colédoco/diagnóstico , Constricción Patológica , Femenino , Hemorragia/etiología , Humanos , Neoplasias Hepáticas/diagnóstico , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/diagnóstico , Pancreatitis/etiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Esfínter de la Ampolla Hepatopancreática/patología , StentsRESUMEN
Objetivo: La esfinterotomía de aguja es una técnica empleada para conseguir el acceso a la vía biliar, cuando los métodos de canulación habituales han fallado. El objetivo ha sido analizar los resultados de la realización de la esfinterotomía de aguja en pacientes con inaccesibilidad a la vía biliar (canulación difícil) mediante técnicas estándar en colangiopancreatografía retrógrada endoscópica, y los factores asociados con el éxito y complicaciones. Material y métodos: Estudio prospectivo que incluye a 72 pacientes entre enero de 1998 y diciembre de 2004, sometidos a esfinterotomía de aguja por canulación difícil de la vía biliar por el mismo endoscopista (J.E.). Los resultados se analizaron respecto al éxito en acceder a la vía biliar, su consecución en una o más sesiones, su posible relación con la enfermedad de base y la incidencia y gravedad de las complicaciones. Resultados: Se realizaron 72 esfinterotomías de aguja de un total de 1.062 esfinterotomías (6,7%). En el 77,7% de los pacientes se colocó previamente una prótesis pancreática. El diagnóstico final fue: coledocolitiasis en el 31,9%; cáncer de páncreas en el 16,6%; colangiocarcinoma en el 13,8%; estenosis benigna en el 8,3%; disfunción del esfínter de Oddi en el 6,9%; normal en el 6,9%, y miscelánea en el 13,8%. Se obtuvo éxito en la canulación en el 87,5% (63/72), y se consiguió en la primera sesión en el 73% (46/63). Se logró el acceso biliar en el 72,7% de los casos (16/22) de neoplasia biliopancreática, frente al 94% (47/50) en pacientes con otros diagnósticos (p = 0,03). Once pacientes (15,2%) presentaron 12 complicaciones (16,6%) (6 pancreatitis, 4 colangitis, 1 hemorragia papilar y 1 relleno de la vena porta). El uso de prótesis pancreática se relacionó con un porcentaje mayor de éxito y menor de complicaciones, alcanzando significación estadística en esta última (p = 0,03).Conclusiones: La esfinterotomía de aguja con prótesis pancreática puede ser un procedimiento seguro en pacientes con canulación difícil de la vía biliar. La presencia de neoplasia biliopancreática es un factor de riesgo de no consecución del acceso biliar frente a otros diagnósticos. La incidencia de complicaciones está en consonancia con otros estudios, y no se han hallado pancreatitis graves ni perforaciones
Objective: Needle-knife sphincterotomy (NKS) is used to achieve biliary access when routine cannulation methods have been unsuccessful. The aim of this study was to analyze the results of NNS in patients with an inaccessible common bile duct (difficult cannulation) using standard techniques in endoscopic retrograde cholangiopancreatography and the factors associated with the success of this procedure and complications. Material and methods: We performed a prospective study of 72 patients who underwent NKS performed by the same endoscopist (J.E.) because of difficult cannulation of the common bile duct between January 1998 and December 2004. The results were analyzed in terms of successful biliary access, whether this was achieved in one or more sessions, its possible association with the underlying disease, and the incidence and severity of complications. Results: Seventy-two NKS were performed from a total of 1062 sphincterotomies (6.7%). A total of 77.7% of the patients underwent prior implantation of a pancreatic prosthesis (NKS-PP). The final diagnosis was: choledocholithiasis (31.9%), cancer of the pancreas (16.6%), cholangiocarcinoma (13.8%), benign stenosis (8.3%), dysfunction of the sphincter of Oddi (6.9%), normal (6.9%), and miscellaneous (13.8%). Cannulation was successful in 87.5% (63/72), and was achieved in the first session in 73% (46/63). Biliary access was achieved in 72.7% of patients (16/22) with biliopancreatic neoplasms versus 94% (47/50) of those with other diagnoses (p = 0.03). Eleven patients (15.2%) presented 12 complications (16.6%) (6 pancreatitis, 4 cholangitis, 1 papillary hemorrhage, and 1 portal vein filling). The use of a pancreatic prosthesis was related to a higher success rate and significantly fewer complications (p = 0.03). Conclusions: NKS-PP can be a safe procedure in patients with difficult cannulation of the common bile duct. The presence of biliopancreatic neoplasm is a risk factor for failure to achieve biliary access compared with other diagnoses. The complication rate was similar to that found in other studies. No cases of severe pancreatitis or perforations were found
Asunto(s)
Humanos , Endoscopios , Esfinterotomía Endoscópica/instrumentación , Ampolla Hepatopancreática/lesiones , Colangiocarcinoma/diagnóstico , Colangitis/etiología , Coledocolitiasis/diagnóstico , Constricción Patológica , Hemorragia/etiología , Pancreatitis/etiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Stents , Neoplasias del Conducto Colédoco/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Esfínter de la Ampolla Hepatopancreática/patologíaRESUMEN
Primary leiomyosarcoma of the liver is a rare entity and fewer than 100 cases have been reported in the medical literature. Even more unusual is the association with another previous tumour. We report the case of a 84-year-old man who had been treated for a gastric non-Hodgkin lymphoma two years previously. He presented with a painful mass in the right upper abdomen. An ultrasound scan showed a large mass in the right lobe of the liver and chest radiography showed pulmonary metastases. Liver biopsy was performed and immunohistochemical analysis revealed a malignant leiomyosarcoma. We discuss this case and review the available literature.
Asunto(s)
Leiomiosarcoma/secundario , Neoplasias Hepáticas/patología , Neoplasias Pulmonares/secundario , Linfoma no Hodgkin/patología , Neoplasias Primarias Múltiples/patología , Neoplasias Gástricas/patología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Leiomiosarcoma/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Linfoma no Hodgkin/terapia , Masculino , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Gástricas/terapiaRESUMEN
No disponible
Asunto(s)
Adulto , Masculino , Humanos , Dolor Abdominal , Lipoma , Neoplasias del ColonRESUMEN
AIM: To determine the current status of endoscopic retrograde cholangiopancreatography (ERCP) and the effects of the introduction of magnetic resonance cholangiography (MRC) on ERCP and to evaluate the diagnostic yield of MRC since its introduction in obstructive biliary disease. MATERIAL AND METHODS: We performed a retrospective analysis of the ERCP carried out between January 1998 and December 2000 and of the MRC performed for suspected obstructive biliary disease from May 1999 to December 2000. When both techniques were performed, the diagnostic yield of MRC was evaluated. RESULTS: We performed 927 ERCP. A total of 45.3% of the patients were men. Mean age was 69.2 14.6 years. Treatment was performed on 688 occasions (77%), mainly sphincterotomy (69.9%) and placement of polyethylene (21.8%) or self-expanding (9.9%) prostheses. The number of ERCP performed each year was 261, 330 and 336 in 1998, 1999 and 2000, respectively; of these 76.6%, 80% and 76.9% were therapeutic. MRC was performed in 63 patients with suspected biliary disease. In 27 of 59 patients (45.8%) MRC was sufficient for diagnosis, avoiding the need for ERCP. In the 35 patients in whom both techniques (MRC and ERCP) were performed, the diagnostic yield of MRC compared with that of ERCP was: sensitivity 100%, specificity 50%, positive predictive value 87.1%, negative predictive value 100% and overall value 89%. The cases responsible for the low specificity (all due to choledocholithiases) were analyzed and a significant time lapse was found between the performance of MRC and ERCP (range: 7-35 days) during which choledocholithiasis probably resolved spontaneously. CONCLUSIONS: a) Contrary to what could be expected, the number of ERCP seems to be increasing with a high percentage of endoscopic treatment; b) Because of its diagnostic sensitivity, MRC is the ideal technique for eliminating the need for diagnostic ERCP, thus allowing greater development of the therapeutic aspect of ERCP.
Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica/métodos , Colestasis/diagnóstico , Imagen por Resonancia Magnética/métodos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Multiple focal nodular hyperplasia is an uncommon benign liver tumor although its incidence has been increasing in the last few years. A case of focal nodular hyperplasia in a young woman is described, which was discovered in infancy and which presented two nodules in each lobe. The diagnosis was subsequently confirmed by large surgical biopsy. Conservative therapy was given for 16 years during which time there was progressive tumor growth, increase of pain and cholestatic enzymes. The unusual presentation this benign lesion may have, a strategy for its diagnosis and the generally conservative management that is currently favored are discussed.
Asunto(s)
Hiperplasia Nodular Focal/diagnóstico , Adulto , Biopsia , Enfermedad Crónica , Femenino , Arteria Hepática/diagnóstico por imagen , Humanos , Hígado/diagnóstico por imagen , Hígado/patología , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XRESUMEN
We present a 68 year old male with alcoholic cirrhosis that was admitted with abdominal pain and fever. Hepatocarcinoma and spontaneous bacterial peritonitis by Listeria monocytogenes was diagnosed. The patient was treated with ampicillin and tobramycin during 25 days following a favorable course although ascitic fluid remained abnormal during 21 days. It is noted the rarity of Listeria as a cause of bacterial peritonitis in cirrhotic patients although they are immunodeficient. It is also important to establish the etiological origin because standard treatment of spontaneous bacterial peritonitis is cefotaxime and Listeria is resistant to this antibiotic. The 66% of spontaneous bacterial peritonitis secondary to Listeria monocytogenes infection in cirrhotic patients has been reported in Spain and this might be due to a higher incidence of human listeriosis in this country.