RESUMEN
Los abscesos del psoas ilíaco secundarios a un tumor de colon fistulizado son excepcionales y potencialmente graves. La mayoría son adenocarcinomas de tipo mucinoso. Su tratamiento es complejo ya que, para lograr una resección oncológica pretendidamente curativa, es necesario realizar una resección ampliada con mayor morbimortalidad. Presentamos el caso de una paciente con un adenocarcinoma mucinoso de colon izquierdo fistulizado al músculo ilíaco y la pared anterolateral del abdomen en la que se realizó una resección multivisceral que incluyó el colon izquierdo, el músculo y la cresta ilíaca y parte de la pared anterolateral del abdomen.
Iliopsoas abscess secondary to perforation of colon cancer is an extremely rare and potentially life-threatening condition. Most tumors are mucinous adenocarcinomas. Its treatment its complex, as most patients need radical extended resections to achieve good oncological results, which are in turn, graved with higher morbidity and mortality. We present the case of a patient with a left colon mucinous adenocarcinoma penetrating to the iliopsoas muscle and the anterolateral abdominal wall that required a multivisceral resection including left colon, iliac muscle and crest and part of the anterolateral abdominal wall.
Abscessos do iliopsoas secundários a um tumor de cólon fistulizado são raros e potencialmente graves. A maioria são adenocarcinomas do tipo mucinoso. Seu tratamento é complexo, pois, para se obter uma ressecção oncológica supostamente curativa, é necessário realizar uma ressecção ampliada com maior morbimortalidade. Apresentamos o caso de um paciente com adenocarcinoma mucinoso de cólon esquerdo fistulizado para o músculo ilíaco e parede ântero-lateral do abdome no qual foi realizada ressecção multivisceral que incluiu cólon esquerdo, músculo e crista ilíaca e parte do a parede anterolateral do abdome.
Asunto(s)
Femenino , Persona de Mediana Edad , Neoplasias del Colon/cirugía , Adenocarcinoma Mucinoso/cirugía , Fístula Intestinal/etiología , Absceso del Psoas/etiología , Colectomía , Neoplasias del Colon/complicaciones , Neoplasias del Colon/diagnóstico por imagen , Adenocarcinoma Mucinoso/complicaciones , Pared Abdominal/patología , Ilion/patologíaRESUMEN
Cardiac rhythm disorders are common in many patients with cancer. The management of synchronous long-standing persistent atrial fibrillation and pulmonary lesions remains a serious surgical dilemma due to the lack of clinical data and surgical guidelines. To the best of our knowledge, this is the first described case of simultaneous thoracoscopic pulmonary segmentectomy and left atrial posterior wall and pulmonary vein isolation combined with left atrial appendage resection in a patient with early-stage primary lung cancer and long-standing persistent atrial fibrillation.
Asunto(s)
Adenocarcinoma Mucinoso , Fibrilación Atrial , Ablación por Catéter , Neoplasias Pulmonares , Adenocarcinoma Mucinoso/complicaciones , Adenocarcinoma Mucinoso/diagnóstico por imagen , Adenocarcinoma Mucinoso/cirugía , Anciano , Apéndice Atrial/cirugía , Fibrilación Atrial/complicaciones , Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Femenino , Atrios Cardíacos/cirugía , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Venas Pulmonares/cirugía , Toracoscopía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Abstract Cardiac rhythm disorders are common in many patients with cancer. The management of synchronous long-standing persistent atrial fibrillation and pulmonary lesions remains a serious surgical dilemma due to the lack of clinical data and surgical guidelines. To the best of our knowledge, this is the first described case of simultaneous thoracoscopic pulmonary segmentectomy and left atrial posterior wall and pulmonary vein isolation combined with left atrial appendage resection in a patient with early-stage primary lung cancer and long-standing persistent atrial fibrillation.
Asunto(s)
Humanos , Femenino , Anciano , Fibrilación Atrial/cirugía , Fibrilación Atrial/complicaciones , Ablación por Catéter/métodos , Adenocarcinoma Mucinoso/cirugía , Adenocarcinoma Mucinoso/complicaciones , Adenocarcinoma Mucinoso/diagnóstico por imagen , Neumonectomía/métodos , Venas Pulmonares/cirugía , Toracoscopía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Apéndice Atrial/cirugía , Atrios Cardíacos/cirugía , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico por imagenRESUMEN
BACKGROUND: We are reporting a rare case of MUTYH-associated polyposis, a colorectal cancer hereditary syndrome, diagnosticated after an intussusception. Colorectal cancer is an important cause of cancer related mortality that can be manifested by an intussusception, a rare occurrence in adults and almost always related to tumors. Approximately 5% of colorectal cancers can be attributed to syndromes known to cause hereditary colorectal cancer, such as MUTYH-associated polyposis, autosomal genetic syndrome associated with this disease. CASE PRESENTATION: We present the case of a 44 years old male, that sought medical consultation with a complaint of abdominal discomfort, that after five days changed its characteristics. The patient was sent to the emergency department were a CT-scan revealed intestinal sub-occlusion by ileocolic invagination. Right colectomy was carried out. The anatomic-pathological examination revealed a moderately differentiated mucinous adenocarcinoma and multiples sessile polyps, which led to the suspicion of a genetic syndrome. In the genetics analysis two mutations were observed in the MUTYH gene, and MUTYH-associated polyposis was diagnosticated. CONCLUSION: This case demonstrates the importance of meticulous analysis of the patient examinations results to identify possible discrete alterations that can lead to improved understanding of disease.
Asunto(s)
Adenocarcinoma Mucinoso/diagnóstico , Poliposis Adenomatosa del Colon/diagnóstico , ADN Glicosilasas/genética , Enfermedades del Íleon/etiología , Intususcepción/etiología , Adenocarcinoma Mucinoso/complicaciones , Adenocarcinoma Mucinoso/genética , Adenocarcinoma Mucinoso/cirugía , Poliposis Adenomatosa del Colon/complicaciones , Poliposis Adenomatosa del Colon/genética , Poliposis Adenomatosa del Colon/cirugía , Adulto , Colectomía , Colon/diagnóstico por imagen , Colon/patología , Colon/cirugía , Predisposición Genética a la Enfermedad , Mutación de Línea Germinal , Humanos , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/cirugía , Intususcepción/diagnóstico por imagen , Intususcepción/cirugía , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Se presenta el caso de una paciente mujer de 53 años procedente de Piura con un tiempo de enfermedad de 20 meses, caracterizado por dolor en sitio de herida quirúrgica por colecistectomía abierta realizada hace 3 años, asociado a presencia de una masa en dicha zona, posteriormente se absceda y comienza a drenar secreción alimentaria. Los estudios de imágenes revelaron una masa dependiente de colon transverso en contacto con estómago y pared abdominal que presentaba fistulas hacia piel. Dicha masa fue extraída durante la cirugía con resultado anatomopatológico de adenocarcinoma mucinoso de colon. El caso representó un reto diagnóstico para el equipo médico y en vista de las diversas manifestaciones clínicas del cáncer de colon, sugerimos mantenerlo presente como diagnóstico diferencial en cuadros de absceso de pared abdominal y fistulizaciones entéricas.
We present the case of a 53-year-old woman with a time of illness of 20 months, characterized by pain at the site of surgical intervention for opened cholecystectomy 3 years ago, associated with a presence of a mass in said area, with the following abscess formation and fistulization of food content. Imaging studies revealed a mass dependent of the transverse colon, in contact with stomach and abdominal wall and presenting fistulas to the skin. Said mass was extracted during surgery with anatomopathological result of mucinous colon adenocarcinoma. The case represented a diagnostic challenge for the medical team and in view of the variaty of clinical manifestations of colonic cancer, we suggest that it should be consider as a differential diagnosis in cases of abdominal wall abscess and enteric fistulas.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Neoplasias Gástricas/patología , Neoplasias del Colon/patología , Adenocarcinoma Mucinoso/patología , Pared Abdominal , Neoplasias Primarias Múltiples/patología , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/complicaciones , Fístula Gástrica/etiología , Fístula Intestinal/etiología , Neoplasias del Colon/cirugía , Neoplasias del Colon/complicaciones , Fístula Cutánea/etiología , Adenocarcinoma Mucinoso/cirugía , Adenocarcinoma Mucinoso/complicaciones , Absceso Abdominal/etiología , Invasividad Neoplásica , Neoplasias Primarias Múltiples/cirugía , Neoplasias Primarias Múltiples/complicacionesRESUMEN
We present the case of a 53-year-old woman with a time of illness of 20 months, characterized by pain at the site of surgical intervention for opened cholecystectomy 3 years ago, associated with a presence of a mass in said area, with the following abscess formation and fistulization of food content. Imaging studies revealed a mass dependent of the transverse colon, in contact with stomach and abdominal wall and presenting fistulas to the skin. Said mass was extracted during surgery with anatomopathological result of mucinous colon adenocarcinoma. The case represented a diagnostic challenge for the medical team and in view of the variaty of clinical manifestations of colonic cancer, we suggest that it should be consider as a differential diagnosis in cases of abdominal wall abscess and enteric fistulas.
Asunto(s)
Pared Abdominal , Adenocarcinoma Mucinoso/patología , Neoplasias del Colon/patología , Neoplasias Primarias Múltiples/patología , Neoplasias Gástricas/patología , Absceso Abdominal/etiología , Adenocarcinoma Mucinoso/complicaciones , Adenocarcinoma Mucinoso/cirugía , Neoplasias del Colon/complicaciones , Neoplasias del Colon/cirugía , Fístula Cutánea/etiología , Femenino , Fístula Gástrica/etiología , Humanos , Fístula Intestinal/etiología , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias Primarias Múltiples/complicaciones , Neoplasias Primarias Múltiples/cirugía , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/cirugíaRESUMEN
INTRODUCTION: Mucinous adenocarcinoma on perianal fistula is a rare entity; it could be underdiagnosed because it behaves often as a regular perianal fistula. MATERIALS AND METHODS: We have recently treated four cases in our unit. We present them and review the literature, emphasizing on clinical characteristic and therapeutic options. The four patients were male with a mean age of 64. Three of them were classified as locally advances cases and therefore treated with neoadjuvant therapy. RESULTS: All of them underwent laparoscopic abdominoperineal escisión. Surgical specimens are described and clinical characteristic specified. Review of the literature shows that this disease has a very high potential risk of local recurrence and we must be aggressive with the resection. Sometimes plastic surgery is needed to reconstruct the perianal wound. CONCLUSIONS: Mucinous adenocarcinoma associated with anal fistula is a rare disease. Neoadjuvant chemoradiotherapy followed by an adequate abdominoperineal excision may result in favourable outcomes.
Asunto(s)
Adenocarcinoma Mucinoso/complicaciones , Adenocarcinoma Mucinoso/patología , Neoplasias del Ano/complicaciones , Neoplasias del Ano/patología , Fístula Rectal/complicaciones , Fístula Rectal/patología , Adulto , Anciano , Anciano de 80 o más Años , Humanos , MasculinoRESUMEN
BACKGROUND: Meckel's diverticulum is the most common congenital anomaly in the small intestine, which results from incomplete obliteration omphalomesenteric duct, usually the diagnosis is incidental, rarely reaching with bleeding, obstruction, diverticulitis or in rare cases a neoplasm. Clinic case: 67 year old woman that started her condition with urinary symptoms (dysuria, frequency, bladder tenesmus and pushing), within the study protocol a cystogram was performed and demonstrated a defect in the bladder dome edges with compression effect, the computed tomography reported a bladder infiltrating hypodense lesion, which is decided to resect finding Meckel's diverticulum with a tumor that infiltrates the bladder dome, the histopathological confirmed the diagnosis shown free edges but insufficient, which need a reintervention to increase margins; all the extension studies shown without tumor activity. CONCLUSIONS: Mucoproductor adenocarcinoma derived from a Meckel's diverticulum is a clinical entity that because of its nonspecific symptomatology and variability of presentation, is diagnosed incidentally on radiological images. The disease has a high mortality rate and a low prevalence.
Antecedentes: el divertículo de Meckel es la anomalía congénita más frecuente en el intestino delgado, que resulta de la obliteración incompleta del conducto onfalomesentérico; su diagnóstico suele ser incidental, pocas veces con sangrado, obstrucción, diverticulitis o en casos raros una neoplasia. Caso clínico: paciente femenina de 67 años de edad, que inició su padecimiento con síntomas urinarios (disuria, polaquiuria, pujo y tenesmo vesical). El cistograma demostró: defecto en el domo de la vejiga, bordes irregulares y efecto de compresión. La tomografía computada reportó: vejiga con lesión hipodensa infiltrante en el domo vesical, al resecarla se encontró un divertículo de Meckel con un tumor infiltrante; el estudio histopatológico confirmó el diagnóstico y demostró los bordes libres; todos los estudios de extensión resultaron sin actividad tumoral. Conclusiones: el adenocarcinoma mucoproductor derivado de un divertículo de Meckel es una entidad clínica que debido a sus síntomas inespecíficos y variabilidad de presentación sólo se diagnostica por lo que se aprecia en las imágenes radiológicas. Este adenocarcinoma tiene un alto índice de mortalidad pero baja prevalencia.
Asunto(s)
Adenocarcinoma Mucinoso/complicaciones , Neoplasias del Íleon/complicaciones , Divertículo Ileal/complicaciones , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/cirugía , Anciano , Femenino , Humanos , Neoplasias del Íleon/diagnóstico , Neoplasias del Íleon/cirugía , Divertículo Ileal/epidemiología , Trastornos Urinarios/etiologíaAsunto(s)
Adenocarcinoma Mucinoso/diagnóstico , Colestasis/terapia , Ictericia Obstructiva/terapia , Neoplasias Hepáticas/secundario , Cuidados Paliativos , Neoplasias Pancreáticas/diagnóstico , Adenocarcinoma Mucinoso/complicaciones , Adenocarcinoma Mucinoso/secundario , Anciano , Colestasis/etiología , Endoscopía del Sistema Digestivo , Humanos , Ictericia Obstructiva/etiología , Neoplasias Hepáticas/diagnóstico por imagen , Metástasis Linfática , Masculino , Conductos Pancreáticos/anomalías , Neoplasias Pancreáticas/complicaciones , Cintigrafía , StentsRESUMEN
Ohashi described for the first time the IPMN on 1982 as a pancreatic neoplasia with mucine cells forming papillae and producing dilatation of the main pancreatic duct or its branches. The IPMN represent the 1% of the pancreatic tumors and 5% of the cystic neoplasias. It is potentially malignant in a period of five years being more frequent in males between 60-70 and clinically these patients' presents as acute, recurrent or chronic pancreatitis, with an incidence of malignancy from 25% to 70%. CT scan and cholangio MRI allows the diagnosis, the variety, localization and possibility of determine malignancy. The treatment is the Whipple resection. We are reporting the case of an obese middle age male, being observed along the last 10 years because of recurrent pancreatitis with a cystic lesion of the head of the pancreas. The CT scan, endoscopic-ultrasound and the analysis of the liquid content suggested a mucinous lesion, reason why the patient underwent a pancreatic-duodenal resection. The histology study confirms the diagnosis of IPMN.
Asunto(s)
Adenocarcinoma Mucinoso/complicaciones , Carcinoma Ductal Pancreático/complicaciones , Neoplasias Pancreáticas/complicaciones , Pancreatitis/complicaciones , Humanos , Masculino , Persona de Mediana Edad , RecurrenciaRESUMEN
La neoplasia Intraductal papilar quística mucinosa (NIPM) fue descrita por primera vez en 1982 por Ohashi, como una neoplasia del páncreas caracterizada por una proliferación de células neoplásicas mucinosas, que forman papilas y causan dilatación del ducto principal o sus ramas. Las NIPM representan el 1% de las neoplasias pancreáticas y el 25% de las neoplasias quísticas. Son potencialmente malignas, progresan desde una lesión benigna hasta carcinoma en un promedio de 5 años. Afecta con mayor frecuencia al sexo masculino entre 60 y 70 años, con síntomas de pancreatitis crónica o pancreatitis aguda recidivante y se localiza preferentemente en la cabeza y proceso uncinado. La clasificación depende de su localización, en variante ducto principal, variante rama lateral o mixto y la importancia radica en el pronóstico, con incidencia de cáncer que varía de 25% a 70%. Las imágenes (T.E.M y Colangio RM) nos permiten establecer el diagnóstico, la variedad, la localización, la extensión y determinar indicios de benignidad o malignidad. Además la eco endoscopía nos permite obtener una muestra y poder estudiar el líquido del quiste. El tratamiento de estas neoplasias es la duodeno pancreatectomía de Whipple. Reportamos un paciente obeso, con historia de pancreatitis recurrente, observado a lo largo de 10 años por una lesión quística del páncreas que creció en los últimos 24 meses. El estudio eco endoscópico y el análisis del líquido del quiste orientó al diagnóstico de NIPM por lo que se le sometió a una resección duodeno pancreática con evolución favorable. El estudio histológico confirmó el diagnóstico de NIPM.
Ohashi described for the first time the IPMN on 1982 as a pancreatic neoplasia with mucine cells forming papillae and producing dilatation of the main pancreatic duct or its branches. The IPMN represent the 1% of the pancreatic tumors and 5% of the cystic neoplasias. It is potentially malignant in a period of five years being more frequent in males between 60-70 and clinically these patients presents as acute, recurrent or chronic pancreatitis, with an incidence of malignancy from 25% to 70%. CT scan and cholangio MRI allows the diagnosis, the variety, localization and possibility of determine malignancy. The treatment is the Whipple resection. We are reporting the case of an obese middle age male, being observed along the last 10 years because of recurrent pancreatitis with a cystic lesion of the head of the pancreas. The CT scan, endoscopic-ultrasound and the analysis of the liquid content suggested a mucinous lesion, reason why the patient underwent a pancreatic-duodenal resection. The histology study confirms the diagnosis of IPMN.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Adenocarcinoma Mucinoso/complicaciones , Carcinoma Ductal Pancreático/complicaciones , Neoplasias Pancreáticas/complicaciones , Pancreatitis/complicaciones , RecurrenciaRESUMEN
BACKGROUND: Ménétrier's disease is a rare disease of the stomach generally described as hypertrophic gastropathy. Its etiology is unknown and its malignant potential is controversial. Only a few reports supporting its association with gastric cancer have been found. We present a case of gastric cancer associated with Ménétrier's disease. CASE REPORT: We present a 72 year-old-male with epigastric pain and early satiety during the last 5 months. He had been treated with proton pump inhibitors with unfavorable response and began with loss of weight and asthenia. An upper digestive endoscopy showed an erythematous nodular gastric mucosa, with enlarged folds. An abdominal CT scan demonstrated a circumferential parietal thickening of the gastric wall and adenopathies. A gastric macrobiopsy done by endoscopic mucosal resection evidenced a mucin infiltrating adenocarcinoma with invasion of the lamina propria. Subtotal gastrectomy was done. The histology showed a stomach with changes compatible with Ménétrier's disease and diffuse infiltration by a highly undifferentiated adenocarcinoma (plastic linitis). CONCLUSION: A patient with diffuse gastric adenocarcinoma and Ménétrier's disease is reported.
Asunto(s)
Adenocarcinoma Mucinoso/complicaciones , Gastritis Hipertrófica/complicaciones , Neoplasias Gástricas/complicaciones , Adenocarcinoma Mucinoso/diagnóstico , Anciano , Gastritis Hipertrófica/diagnóstico , Gastroscopía , Humanos , Masculino , Neoplasias Gástricas/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To present a rare case of well-differentiated mucus-producing adenocarcinoma of the renal pelvis. METHODS: Patient history, the results of the complementary tests after surgery, treatment and anatomopathological findings are presented. RESULTS/CONCLUSIONS: Well-differentiated mucus-producing adenocarcinoma of the renal pelvis is rare and is often associated with lithiasis, a long history of obstruction and inflammation. Nests of tumor cells surrounded by abundant mucus is a characteristic histological finding in this tumor type.
Asunto(s)
Adenocarcinoma Mucinoso/patología , Neoplasias Renales/patología , Adenocarcinoma Mucinoso/complicaciones , Adulto , Femenino , Humanos , Cálculos Renales/terapia , Neoplasias Renales/complicaciones , Embarazo , Complicaciones del Embarazo/terapiaRESUMEN
Se presenta el caso de una paciente postmenopáusica portadora de un cistoadenocarcinoma mucinoso de bajo potencial maligno del ovario con hiperplasia del estroma y signos de virilización. Se destaca su perfil hormonal alterado y su normalización postquirúrgica
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Adenocarcinoma Mucinoso/diagnóstico , Neoplasias Ováricas/diagnóstico , Adenocarcinoma Mucinoso/complicaciones , Adenocarcinoma Mucinoso/cirugía , Histerectomía , Posmenopausia , Virilismo/etiologíaRESUMEN
A 61 year old male with a localized gastric cancer developed a post-operative pneumonia by C. diversus which was isolated from blood and from bronchoalveolar lavage. A satisfactory response was observed after treatment with penicillin and amikacin. A brief review of the literature concerning the clinical relevance of infections by this unusual agent is offered.
Asunto(s)
Bacteriemia/microbiología , Citrobacter/aislamiento & purificación , Infecciones por Enterobacteriaceae/microbiología , Neumonía/microbiología , Adenocarcinoma Mucinoso/complicaciones , Líquido del Lavado Bronquioalveolar , Citrobacter/clasificación , Humanos , Masculino , Persona de Mediana Edad , Neumonía/complicaciones , Complicaciones Posoperatorias , Neoplasias Gástricas/complicacionesAsunto(s)
Persona de Mediana Edad , Humanos , Masculino , Neumonía/microbiología , Citrobacter/aislamiento & purificación , Bacteriemia , Infecciones por Enterobacteriaceae , Neumonía/complicaciones , Complicaciones Posoperatorias , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/complicaciones , Citrobacter/clasificación , Líquido del Lavado Bronquioalveolar , Adenocarcinoma Mucinoso/cirugía , Adenocarcinoma Mucinoso/complicacionesRESUMEN
Four cases of familial polyposis coli (FPC), seen at Dr. Manuel Gea González General Hospital from 1985 to 1987, are presented. Three females and one male, with ages ranging between 23 and 52 years, are presented. The clinical picture included bloody feces, polyp prolapse, and a maxillary osteoma. In 3 cases the correct preoperative diagnosis was made by rectosigmoidoscopy, biopsy and barium enema. In one patient, urgently operated on, the diagnosis was postoperatively made by colonoscopy. The adenocarcinoma of the colon appeared associated with FPC in three cases (one of the mucinous variety). One total coloproctectomy and two abdominal colectomies with ileorectal anastomosis were performed. One patient operated on because of bowel obstruction was treated by right hemicolectomy. This case developed abdominal carcinomatosis afterwards. One woman died; another one was lost during follow-up, and the other one had no complications. The association of FPC and mucinous adenocarcinoma of the colon is reported for the first time.
Asunto(s)
Adenocarcinoma Mucinoso/complicaciones , Poliposis Adenomatosa del Colon/complicaciones , Neoplasias del Colon/complicaciones , Adenocarcinoma Mucinoso/patología , Adenocarcinoma Mucinoso/cirugía , Poliposis Adenomatosa del Colon/patología , Poliposis Adenomatosa del Colon/cirugía , Adulto , Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
É analisado o comportamento da associaçäo câncer gástrico e úlcera duodenal em pacientes acompanhados no Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo. No período compreendido entre janeiro de 1980 e fevereiro de 1984, constatou-se presença da associaçäo câncer gástrico/úlcera duodenal em seis paciente. Estes pacientes foram estudados quanto a faixa etária, sexo, raça, classificaçäo endoscópica da neoplasia e sua localizaçäo na câmara gástrica. A associaçäo de câncer gástrico com úlcera duodenal é pouco freqüente e os parâmetros estudados confirmam a experiência de outros pesquisadores näo permitindo, entretanto, conlusöes definitivas, tendo em vista a pequena casuística. Contudo, vale ressaltar que todo paciente portador de úlcera duodenal que apresente história clínica atípica ou mudança da sintomatologia inicial, deve ser cuidadosamente examinado, porquanto esta afecçäo näo isenta o eventual desenvolvimento do câncer gástrico
Asunto(s)
Adulto , Persona de Mediana Edad , Humanos , Masculino , Adenocarcinoma/complicaciones , Adenocarcinoma Mucinoso/complicaciones , Neoplasias Gástricas/complicaciones , Úlcera Duodenal/complicaciones , Adenocarcinoma/diagnóstico , Adenocarcinoma Mucinoso/diagnóstico , Endoscopía , Neoplasias Gástricas/diagnóstico , Úlcera Duodenal/diagnósticoRESUMEN
The clinical and pathological features of 24 patients with cerebral emboli complicating 66% of our cases of nonbacterial thrombotic endocarditis (NBTE) associated with carcinoma are reviewed. Twelve patients were admitted for a cerebrovascular accident (CVA) while 4 patients developed a CVA during hospitalization. Transient ischemic attacks preceded the CVA in 3 patients. More often the CVA took the form of a single sudden accident. Cerebral infarcts however were generally multiple and hemorrhagic and varied in size and age. In 4 patients large softenings were directly responsible for death. 8.6% of cerebral embolisms were caused by NBTE and in 10 patients cerebral embolization was the first symptom of a carcinoma. The frequency of NBTE in ovarian carcinoma even in the absence of metastases may motivate a more aggressive approach towards unexplained cerebral embolism.