RESUMEN
Lung tumorlets are rare neuroendocrine neoplasms of 0.5 cm or less in diameter that extend beyond the basement membrane. Although they are associated with bronchiectasis and fibrosis they tend to be asymptomatic and behave in a benign way, usually being diagnosed as incidental microscopic nests of neuroendocrine cells in lung tissue. We present a case of a pulmonary tumorlet finding after right upper lobectomy for lung cancer.
Los tumorlets pulmonares son neoplasias neuroendocrinas poco frecuentes, que se extienden más allá de la membrana basal y miden 0.5 cm o menos de diámetro. Aunque suelen asociarse a bronquiectasias y fibrosis pulmonar, suelen ser asintomáticas comportándose de una manera indolente, siendo usualmente diagnosticadas de forma incidental en el estudio microscópico de una pieza pulmonar. Presentamos el caso de un tumorlet pulmonar incidental luego de una lobectomía superior derecha por cáncer de pulmón.
Asunto(s)
Adenoma , Tumor Carcinoide , Carcinoma Neuroendocrino , Neoplasias Pulmonares , Tumor Carcinoide/complicaciones , Tumor Carcinoide/diagnóstico por imagen , Tumor Carcinoide/cirugía , Humanos , Pulmón , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico por imagenRESUMEN
Cecal appendix tumors are extremely rare (less than 0.5%), with carcinoid tumors being described as the most common type of appendix tumor. A case of a 32-year-old male patient is reported, with no significant pathological history, with acute abdomen data. Laparoscopic appendectomy was decided, presenting findings of an appendicular inflammatory process, resulting in a neuroendocrine tumor histopathology report. Despite the fact that appendix neoplasias are rare, appendicitis is a common presentation, hence the importance of conducting histopathology studies on every piece of cecal appendix obtained.
Los tumores de apéndice cecal son extremadamente raros (menos del 0.5%), y los tumores carcinoides se describen como el tipo de tumor apendicular más frecuente. Se reporta el caso de un paciente de 32 años, sin antecedentes patológicos de importancia, con datos de abdomen agudo. Se decidió apendicectomía laparoscópica, presentando hallazgos de proceso inflamatorio apendicular, con reporte de histopatología de tumor neuroendocrino. Pese a que las neoplasias de apéndice son raras, la apendicitis es una presentación común, y de ahí la importancia de realizar estudios histopatológicos de toda pieza de apéndice cecal obtenida.
Asunto(s)
Neoplasias del Apéndice , Apendicitis , Apéndice , Tumor Carcinoide , Laparoscopía , Adulto , Apendicectomía , Neoplasias del Apéndice/cirugía , Apendicitis/cirugía , Apéndice/cirugía , Tumor Carcinoide/cirugía , Humanos , MasculinoRESUMEN
Carcinoid tumors can be a cause for right heart valve disease, also known as Hedinger syndrome or carcinoid heart disease. Proper understanding of the pathophysiology is of the uttermost importance for adequate treatment of these patients, especially during heart surgery.
Asunto(s)
Cardiopatía Carcinoide , Tumor Carcinoide , Enfermedades de las Válvulas Cardíacas , Humanos , Cardiopatía Carcinoide/cirugía , Enfermedades de las Válvulas Cardíacas/cirugía , Tumor Carcinoide/cirugía , SíndromeRESUMEN
Resumen: Los tumores neuroendocrinos primarios (NET) del mediastino son muy raros. Presentamos el caso de un tumor carcinoide atípico primario de timo. Un hombre de 52 años que fue a un examen médico porque se quejaba de tos no productiva sin hemoptisis. Se solicitó una radiografía de tórax donde se evidenció un mediastino notablemente ensanchado, con una tomografía de tórax que mostro una masa tumoral de 90 x 50 mm en el mediastino anterosuperior que comprime el arco aórtico y la arteria pulmonar sin un plano de clivaje adecuado. Debido a que el tumor era infiltrativo, se proporcionó escisión quirúrgica completa, quimioterapia y radioterapia al mediastino. El objetivo principal de nuestro estudio fue evaluar los hallazgos de CT y MRI con relación a la literatura mundial.
Abstract: Primary neuroendocrine tumors (NET) of the mediastinum are very rare. We present the case of a primary atypical carcinoid tumor of the thymus. A 52-year-old man who went to a medical examination because he complained of a non-productive cough without hemoptysis. A chest radiograph was requested where a markedly widened mediastinum was evidenced, with a thoracic tomography showing a tumor mass of 90 x 50 mm in the anterosuperior mediastinum that compresses the aortic arch and pulmonary artery without an adequate cleavage plane. Because the tumor was infiltrative, complete surgical excision, chemotherapy and radiotherapy were provided to the mediastinum. The main objective of our study was to evaluate the findings of CT and MRI in relation to universal literature.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Neoplasias del Timo/diagnóstico por imagen , Tumor Carcinoide/diagnóstico por imagen , Tumores Neuroendocrinos/diagnóstico por imagen , Neoplasias del Timo/cirugía , Tumor Carcinoide/cirugía , Radiografía Torácica , Tomografía Computarizada por Rayos X , Tumores Neuroendocrinos/cirugía , Mediastino/patologíaRESUMEN
Sleeve resection is used in central lung cancer and the objective is to preserve normal lung tissues. Uniportal VATS approach is a complex and challenging new technique that offers the benefits of minimal invasion, without increasing the risks. We presented a 41-year-old male patient, with history of cough with hemoptysis due to an exophytic lesion of the right main bronchus. Diagnosis of neuroendocrine tumor type 1 (carcinoid tumor) was confirmed with bronchoscopy. Complete circumferential resection was performed, with terminal-terminal anastomosis and reconstruction. Satisfactory postoperative evolution. In post-surgical follow-up.
La resección bronquial en manga se emplea en tumores pulmonares que invaden estructuras centrales con el objetivo de preservar tejido pulmonar funcional. El abordaje VATS uniportal es una técnica novel compleja y desafiante, que ofrece los beneficios de la mínima invasión sin incrementar los riesgos. Presentamos el caso de un paciente de 41 años con un cuadro de tos con hemoptisis por lesión exofítica del bronquio principal derecho confirmada por broncoscopia, con diagnóstico de tumor neuroendocrino de tipo 1 (tumor carcinoide), que fue resecado por completo circunferencialmente, con reconstrucción término-terminal. La evolución posoperatoria fue satisfactoria. El seguimiento se realiza en consulta externa.
Asunto(s)
Bronquios/cirugía , Neoplasias de los Bronquios/cirugía , Tumor Carcinoide/cirugía , Adulto , Neoplasias de los Bronquios/diagnóstico por imagen , Broncoscopía , Tumor Carcinoide/diagnóstico por imagen , Humanos , Masculino , Cuidados Preoperatorios , Cirugía Torácica Asistida por Video/métodos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To analyze determinants of prognosis in patients with bronchial carcinoid tumors treated surgically and the potential concomitance of such tumors with second primary neoplasms. METHODS: This was a retrospective analysis of 51 bronchial carcinoid tumors treated surgically between 2007 and 2016. Disease-free survival (DFS) was calculated by the Kaplan-Meier method, and determinants of prognosis were evaluated. Primary neoplasms that were concomitant with the bronchial carcinoid tumors were identified by reviewing patient charts. RESULTS: The median age was 51.2 years, 58.8% of the patients were female, and 52.9% were asymptomatic. The most common histology was typical carcinoid (in 80.4%). Five-year DFS was 89.8%. Ki-67 expression was determined in 27 patients, and five-year DFS was better among the patients in whom Ki-67 expression was ≤ 5% than among those in whom it was > 5% (100% vs. 47.6%; p = 0.01). Concomitant primary neoplasms were observed in 14 (27.4%) of the 51 cases. Among the concomitant primary neoplasms that were malignant, the most common was lung adenocarcinoma, which was observed in 3 cases. Concomitant primary neoplasms were more common in patients who were asymptomatic and in those with small tumors. CONCLUSIONS: Surgical resection is the mainstay treatment of bronchopulmonary carcinoid tumors and confers a good prognosis. Bronchial carcinoid tumors are likely to be accompanied by second primary neoplasms.
Asunto(s)
Neoplasias de los Bronquios/cirugía , Tumor Carcinoide/cirugía , Neoplasias Primarias Secundarias/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de los Bronquios/patología , Tumor Carcinoide/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Antígeno Ki-67/análisis , Tiempo de Internación , Masculino , Persona de Mediana Edad , Neoplasias Primarias Secundarias/patología , Estudios Retrospectivos , Estadísticas no Paramétricas , Factores de Tiempo , Adulto JovenRESUMEN
ABSTRACT Objective: To analyze determinants of prognosis in patients with bronchial carcinoid tumors treated surgically and the potential concomitance of such tumors with second primary neoplasms. Methods: This was a retrospective analysis of 51 bronchial carcinoid tumors treated surgically between 2007 and 2016. Disease-free survival (DFS) was calculated by the Kaplan-Meier method, and determinants of prognosis were evaluated. Primary neoplasms that were concomitant with the bronchial carcinoid tumors were identified by reviewing patient charts. Results: The median age was 51.2 years, 58.8% of the patients were female, and 52.9% were asymptomatic. The most common histology was typical carcinoid (in 80.4%). Five-year DFS was 89.8%. Ki-67 expression was determined in 27 patients, and five-year DFS was better among the patients in whom Ki-67 expression was ≤ 5% than among those in whom it was > 5% (100% vs. 47.6%; p = 0.01). Concomitant primary neoplasms were observed in 14 (27.4%) of the 51 cases. Among the concomitant primary neoplasms that were malignant, the most common was lung adenocarcinoma, which was observed in 3 cases. Concomitant primary neoplasms were more common in patients who were asymptomatic and in those with small tumors. Conclusions: Surgical resection is the mainstay treatment of bronchopulmonary carcinoid tumors and confers a good prognosis. Bronchial carcinoid tumors are likely to be accompanied by second primary neoplasms.
RESUMO Objetivo: Analisar os determinantes do prognóstico em pacientes com tumores carcinoides brônquicos tratados cirurgicamente e possível segunda neoplasia primária concomitante. Métodos: Trata-se de uma análise retrospectiva de 51 tumores carcinoides brônquicos tratados cirurgicamente entre 2007 e 2016. A sobrevida livre de doença (SLD) foi calculada pelo método de Kaplan-Meier, e os determinantes do prognóstico foram avaliados. As neoplasias primárias concomitantes aos tumores carcinoides brônquicos foram identificadas por meio da análise dos prontuários dos pacientes. Resultados: A mediana de idade foi de 51,2 anos, 58,8% dos pacientes eram do sexo feminino e 52,9% eram assintomáticos. A classificação histológica mais comum foi carcinoide típico (em 80,4%). A SLD em cinco anos foi de 89,8%. A expressão de Ki-67 foi determinada em 27 pacientes, e a SLD em cinco anos foi melhor nos pacientes nos quais a expressão de Ki-67 foi ≤ 5% do que naqueles nos quais a expressão de Ki-67 foi > 5% (100% vs. 47,6%; p = 0,01). Neoplasias primárias concomitantes foram observadas em 14 (27,4%) dos 51 casos. Entre as neoplasias primárias malignas concomitantes, a mais comum foi o adenocarcinoma pulmonar, observado em 3 casos. Neoplasias primárias concomitantes foram mais comuns em pacientes assintomáticos e naqueles com tumores pequenos. Conclusões: A resseção cirúrgica é o principal tratamento de tumores carcinoides broncopulmonares e propicia um bom prognóstico. É provável que tumores carcinoides brônquicos se relacionem com segunda neoplasia primária.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Neoplasias de los Bronquios/cirugía , Tumor Carcinoide/cirugía , Neoplasias Primarias Secundarias/cirugía , Factores de Tiempo , Neoplasias de los Bronquios/patología , Tumor Carcinoide/patología , Estudios Retrospectivos , Neoplasias Primarias Secundarias/patología , Estadísticas no Paramétricas , Supervivencia sin Enfermedad , Antígeno Ki-67/análisis , Tiempo de InternaciónRESUMEN
Ki-67 has shown promise as a prognostic factor in pulmonary carcinoids. In this study, we sought to validate the importance of Ki-67 and study the relationships between Ki-67 and other stromal biomarkers of vascular density. We examined Ki-67, CD34, and D2-40 in tumor tissues from 128 patients with surgically excised typical carcinoid of the lung. We used immunohistochemistry and morphometry to evaluate the amount of tumor staining for cellular proliferation (Ki-67), microvascular density (CD34-MVD), and D2-40 lymphovascular density. The main outcome was overall survival, considered as life expectancy until death from metastasis. Specimens from patients with central tumors showed high CD34-MVD (P = .01), which was also significantly associated with a compromised surgical margin, lymph node metastasis, and clinical stage Ib. Equally significant was high D2-40 lymphovascular density in central specimens with a compromised surgical margin and lymph node metastasis. A high Ki-67 proliferation rate was significantly associated with tumors from patients with clinical stage IIb, IIIa, and IV disease. Multivariate Cox model analysis demonstrated that tumor location and stage, surgical margin, tumor size, and N stage were significantly related to survival time (P < .05). Quantitative staining of the tumor for Ki-67 and CD34-MVD served as prognostic factors (P < .05), which were more relevant than the surgical and pathological stage. Ki-67 greater than 5% and CD34-MVD greater than 7% staining comprise a subset of patients with higher death hazard; this outcome may harbor evidence for further prospective studies of target therapy after surgical resection.
Asunto(s)
Anticuerpos Monoclonales de Origen Murino/inmunología , Antígenos CD34/análisis , Capilares/química , Tumor Carcinoide/química , Proliferación Celular , Inmunoquímica/métodos , Antígeno Ki-67/análisis , Neoplasias Pulmonares/química , Linfangiogénesis , Vasos Linfáticos/química , Neovascularización Patológica , Adolescente , Adulto , Anciano , Capilares/patología , Tumor Carcinoide/mortalidad , Tumor Carcinoide/secundario , Tumor Carcinoide/cirugía , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Metástasis Linfática , Vasos Linfáticos/patología , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Estadificación de Neoplasias , Neumonectomía , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Carga Tumoral , Adulto JovenRESUMEN
Los tumores carcinoides apendiculares son infrecuentes, aparecen principalmente en el sexo femenino entre la tercera y cuarta década de la vida; generalmente su diagnóstico es un hallazgo incidental anatomopatológico en el curso de una apendicitis aguda. Objetivo: Describir el caso de una paciente con un tumor carcinoide del apéndice cecal. Presentación de caso: Paciente femenina de 41 años, con dolor abdominal en fosa ilíaca derecha de un día de evolución, acompañado de náuseas; al examen físico presentaba dolor a la descompresión en esa región, el resto del abdomen sin signos de peritonismo. Mediante la tomografía computarizada contrastada de abdomen se constató una apendicitis aguda, se le realizó apendicectomía laparoscópica de urgencia. Después del análisis anatomopatológico e inmunohistoquímico de la pieza quirúrgica extraída se evidenció la existencia de un tumor carcinoide bien diferenciado del apéndice cecal. Conclusiones: La paciente evolucionó favorablemente sin complicaciones posoperatorias, no fue necesario realizar otros manejos quirúrgicos aparte de la apendicectomía simple(AU)
Appendicular carcinoid tumors are uncommon, occurring mainly in the female sex between the third and fourth decade of life; usually its diagnosis is an incidental anatomopathological finding in the course of an acute appendicitis. Objective: To describe the case of a patient with a carcinoid tumor of the cecal appendix. Case presentation: A 41-year-old female patient with abdominal pain in the right iliac fossa with day of evolution, accompanied by nausea; at the physical examination she presented pain at the decompression in that region, the rest of the abdomen without signs of peritonism. An acute appendicitis was confirmed by abdominal computed tomography (CT), and emergency laparoscopic appendectomy was performed. After the anatomopathological and immunohistochemical analysis of the extracted surgical specimen, there was evidence of a well differentiated carcinoid tumor of the cecal appendix. Conclusions: The patient progressed favorably without postoperative complications, it was not necessary to perform other surgical procedures other than simple appendectomy(AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Tumor Carcinoide/cirugía , /cirugía , Tomografía Computarizada por Rayos X/métodos , Apendicitis/complicaciones , ApendicectomíaRESUMEN
Fundamento: Los tumores carcinoides apendiculares son infrecuentes, aparecen principalmente en el sexo femenino entre la tercera y cuarta década de la vida; generalmente su diagnóstico es un hallazgo incidental anatomopatológico en el curso de una apendicitis aguda. Objetivo: Describir el caso de una paciente con un tumor carcinoide del apéndice cecal. Presentación de caso: Paciente femenina de 41 años, con dolor abdominal en fosa ilíaca derecha de un día de evolución, acompañado de náuseas; al examen físico presentaba dolor a la descompresión en esa región, el resto del abdomen sin signos de peritonismo. Mediante la tomografía computarizada contrastada de abdomen se constató una apendicitis aguda, se le realizó apendicectomía laparoscópica de urgencia. Después del análisis anatomopatológico e inmunohistoquímico de la pieza quirúrgica extraída se evidenció la existencia de un tumor carcinoide bien diferenciado del apéndice cecal. Conclusiones: La paciente evolucionó favorablemente sin complicaciones posoperatorias, no fue necesario realizar otros manejos quirúrgicos aparte de la apendicectomía simple (AU)
Asunto(s)
Humanos , Tumor Carcinoide/cirugía , Apendicectomía/instrumentaciónRESUMEN
PURPOSE: Primary lung tumors are rare during childhood and encompass a wide variety of histological types. Each has a different biology and a different therapeutic approach. The aim of this article is to review the experience of a pediatric referral center with this kind of tumors during the last 24 years. METHODS: A retrospective chart review was performed for patients with diagnosis of primary lung tumor between the years 1990-2014. The variables analyzed were age, sex, course of the disease, symptoms, localization, surgery, histology and outcome. RESULTS: Between 1990 and 2014, 38 patients with primary lung tumors were treated at our institution. Age at presentation was 6.6 ± 5.2 years (r 0.91-16.58) and the female:male relationship was 1.37. Inflammatory myofibroblastic lung tumor (n = 13), carcinoid tumor (n = 6) and pleuropulmonary blastoma (n = 6) were the most frequent histological types. Persistent radiographic abnormality was the most frequent presenting sign (34 %). Global mortality was 15.8 % varying according to histology. CONCLUSION: Although the diagnosis of primary lung tumor is rare, the persistence of a radiographic abnormality in spite of adequate treatment for inflammatory processes forces us to evaluate further. The age of the patient is an important factor in the decision of the diagnostic work-up.
Asunto(s)
Neoplasias Pulmonares/diagnóstico , Adolescente , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirugía , Niño , Preescolar , Femenino , Humanos , Lactante , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/cirugía , Masculino , Neoplasias de Tejido Muscular/diagnóstico , Neoplasias de Tejido Muscular/cirugía , Blastoma Pulmonar/diagnóstico , Blastoma Pulmonar/cirugía , Derivación y Consulta , Estudios RetrospectivosRESUMEN
OBJECTIVE: To characterize the pattern of primary small bowel cancers in a tertiary East-European hospital. METHODS: A retrospective study of patients with small bowel cancers admitted to a tertiary emergency center, over the past 15 years. RESULTS: There were 57 patients with small bowel cancer, representing 0.039% of admissions and 0.059% of laparotomies. There were 37 (64.9%) men, mean age of 58 years; and 72 years for females. Out of 57 patients, 48 (84.2%) were admitted due to an emergency situation: obstruction in 21 (38.9%), perforation in 17 (31.5%), upper gastrointestinal bleeding in 8 (14.8%), and lower gastrointestinal bleeding in 2 (3.7%). There were 10 (17.5%) duodenal tumors, 21 (36.8%) jejunal tumors and 26 (45.6%) ileal tumors. The most frequent neoplasms were gastrointestinal stromal tumor in 24 patients (42.1%), adenocarcinoma in 19 (33.3%), lymphoma in 8 (14%), and carcinoids in 2 (3.5%). The prevalence of duodenal adenocarcinoma was 14.55 times greater than that of the small bowel, and the prevalence of duodenal stromal tumors was 1.818 time greater than that of the small bowel. Obstruction was the complication in adenocarcinoma in 57.9% of cases, and perforation was the major local complication (47.8%) in stromal tumors. CONCLUSION: Primary small bowel cancers are usually diagnosed at advanced stages, and revealed by a local complication of the tumor. Their surgical management in emergency setting is associated to significant morbidity and mortality rates.
Asunto(s)
Adenocarcinoma/complicaciones , Tumor Carcinoide/complicaciones , Hemorragia Gastrointestinal/etiología , Tumores del Estroma Gastrointestinal/complicaciones , Neoplasias Intestinales/complicaciones , Obstrucción Intestinal/etiología , Perforación Intestinal/etiología , Adenocarcinoma/mortalidad , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Tumor Carcinoide/mortalidad , Tumor Carcinoide/cirugía , Neoplasias Duodenales/complicaciones , Neoplasias Duodenales/mortalidad , Neoplasias Duodenales/cirugía , Servicios Médicos de Urgencia/estadística & datos numéricos , Europa Oriental , Femenino , Tumores del Estroma Gastrointestinal/mortalidad , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Neoplasias del Íleon/complicaciones , Neoplasias del Íleon/mortalidad , Neoplasias del Íleon/cirugía , Hallazgos Incidentales , Neoplasias Intestinales/mortalidad , Neoplasias Intestinales/cirugía , Neoplasias del Yeyuno/complicaciones , Neoplasias del Yeyuno/mortalidad , Neoplasias del Yeyuno/cirugía , Linfoma/complicaciones , Linfoma/mortalidad , Linfoma/cirugía , Masculino , Persona de Mediana Edad , Admisión del Paciente , Prevalencia , Estudios Retrospectivos , Centros de Atención Terciaria/estadística & datos numéricos , Adulto JovenRESUMEN
ABSTRACT Objective To characterize the pattern of primary small bowel cancers in a tertiary East-European hospital. Methods A retrospective study of patients with small bowel cancers admitted to a tertiary emergency center, over the past 15 years. Results There were 57 patients with small bowel cancer, representing 0.039% of admissions and 0.059% of laparotomies. There were 37 (64.9%) men, mean age of 58 years; and 72 years for females. Out of 57 patients, 48 (84.2%) were admitted due to an emergency situation: obstruction in 21 (38.9%), perforation in 17 (31.5%), upper gastrointestinal bleeding in 8 (14.8%), and lower gastrointestinal bleeding in 2 (3.7%). There were 10 (17.5%) duodenal tumors, 21 (36.8%) jejunal tumors and 26 (45.6%) ileal tumors. The most frequent neoplasms were gastrointestinal stromal tumor in 24 patients (42.1%), adenocarcinoma in 19 (33.3%), lymphoma in 8 (14%), and carcinoids in 2 (3.5%). The prevalence of duodenal adenocarcinoma was 14.55 times greater than that of the small bowel, and the prevalence of duodenal stromal tumors was 1.818 time greater than that of the small bowel. Obstruction was the complication in adenocarcinoma in 57.9% of cases, and perforation was the major local complication (47.8%) in stromal tumors. Conclusion Primary small bowel cancers are usually diagnosed at advanced stages, and revealed by a local complication of the tumor. Their surgical management in emergency setting is associated to significant morbidity and mortality rates.
RESUMO Objetivo Caracterizar o padrão de neoplasias malignas primárias do intestino delgado em um hospital terciário de Leste Europeu. Métodos Estudo retrospectivo de pacientes com câncer de intestino delgado, internados em um hospital terciário e de emergência, ao longo dos últimos 15 anos. Resultados Foram avaliados 57 pacientes com neoplasias malignas gastrintestinais, o que representou 0,039% das admissões e 0,059% das laparotomias realizadas. Total de 37 (64,9%) pacientes masculinos, média de idade de 58 anos, e de 72 anos para mulheres. Dentre os 57 pacientes, 48 (84,2%) foram internados em situação de emergência: obstrução intestinal em 21 (38,9%), perfuração em 17 (31,5%), hemorragia digestiva alta em 8 (14,8%), e hemorragia digestiva baixa em 2 (3,7%). Houve 10 (17,5%) tumores duodenais, 21 (36,8%) jejunais e 26 (45,6%) ileais. As neoplasias mais frequentes foram tumor estromal gastrintestinal, em 24 (42,1%) pacientes, adenocarcinoma em 19 (33,3%), linfoma em 8 (14%) e carcinoides em 2 (3,5%). A prevalência de adenocarcinoma duodenal foi 14,55 vezes maior do que a do intestino delgado, e a prevalência de tumores estromais duodenais foi 1,818 vez maior do que a do intestino delgado. A obstrução intestinal foi complicação do adenocarcinoma em 57,9% dos casos, e a perfuração foi a principal complicação local (47,8%) dos tumores estromais. Conclusão As neoplasias malignas primárias do intestino delgado foram geralmente diagnosticadas em estado avançado e reveladas por uma complicação local do tumor. O tratamento cirúrgico em situação de emergência está associado à significativa morbimortalidade.
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Adenocarcinoma/complicaciones , Tumor Carcinoide/complicaciones , Hemorragia Gastrointestinal/etiología , Tumores del Estroma Gastrointestinal/complicaciones , Neoplasias Intestinales/complicaciones , Obstrucción Intestinal/etiología , Perforación Intestinal/etiología , Adenocarcinoma/mortalidad , Adenocarcinoma/cirugía , Tumor Carcinoide/mortalidad , Tumor Carcinoide/cirugía , Neoplasias Duodenales/complicaciones , Neoplasias Duodenales/mortalidad , Neoplasias Duodenales/cirugía , Europa Oriental , Servicios Médicos de Urgencia/estadística & datos numéricos , Tumores del Estroma Gastrointestinal/mortalidad , Tumores del Estroma Gastrointestinal/cirugía , Hallazgos Incidentales , Neoplasias del Íleon/complicaciones , Neoplasias del Íleon/mortalidad , Neoplasias del Íleon/cirugía , Neoplasias Intestinales/mortalidad , Neoplasias Intestinales/cirugía , Neoplasias del Yeyuno/complicaciones , Neoplasias del Yeyuno/mortalidad , Neoplasias del Yeyuno/cirugía , Linfoma/complicaciones , Linfoma/mortalidad , Linfoma/cirugía , Admisión del Paciente , Prevalencia , Estudios Retrospectivos , Centros de Atención Terciaria/estadística & datos numéricosRESUMEN
BACKGROUND: Carcinoid of the small intestine, is a well-differentiated neuroendocrine tumor that rarely presents with clinical signs. This tumour can be associated with other conditions, such as inflammatory bowel disease, presenting a wide range of symptoms. In some cases they have an aggressive and highly symptomatic behaviour; thus, clinical suspicion must be high to make an early diagnosis. CLINICAL CASE: A 60 year-old male patient with Crohn's disease and gastrointestinal symptoms attributed to this disease within the last year. He presented with intestinal obstruction initially treated with conservative management with no improvement. Exploratory laparotomy was performed finding a mesenteric tumour that caused the bowel obstruction. Bowel resection with primary anastomosis was performed. The pathology report showed an intestinal carcinoid tumour with lymph node metastases. The patient recovered well, and was discharged without complications to continue medical treatment and follow-up by the Oncology department. CONCLUSION: In almost 42% of the cases, the most common site of carcinoid tumours is the small intestine, and of these, 41% are presented as locoregional disease. Patients with Crohn's disease present a higher incidence. In these cases, the most common presentation is an acute intestinal obstruction (90%). Surgery is usually curative, and follow up is important as the symptoms of Crohn's disease can hide any recurrence.
Asunto(s)
Tumor Carcinoide/secundario , Enfermedad de Crohn/complicaciones , Neoplasias del Íleon/diagnóstico , Obstrucción Intestinal/etiología , Neoplasias del Mediastino/secundario , Tumor Carcinoide/complicaciones , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirugía , Diagnóstico Tardío , Susceptibilidad a Enfermedades , Humanos , Neoplasias del Íleon/patología , Neoplasias del Íleon/cirugía , Obstrucción Intestinal/cirugía , Metástasis Linfática , Masculino , Neoplasias del Mediastino/complicaciones , Neoplasias del Mediastino/diagnóstico , Neoplasias del Mediastino/cirugía , Persona de Mediana Edad , Invasividad NeoplásicaRESUMEN
The discovery of an appendiceal carcinoid tumor found incidentally or during the course of diagnostic or therapeutic procedures is a burden to both the patient and clinician. The role of the correct surgical operation is paramount for lesions suspected to be malignant. In the pediatric population, appendiceal carcinoids continue to challenge the clinician in choosing the optimal treatment when lesions are larger than 2 cm or involve the appendical base. While the criteria used to define these distinct lesions are available in most cases, the management and treatment are still debated and controversial when considering more radical surgical intervention. The purpose of this article is to give an overview regarding the history, diagnosis, histopathology, management, and controversies associated with appendiceal carcinoid in the pediatric population.
Asunto(s)
Neoplasias del Apéndice/cirugía , Tumor Carcinoide/cirugía , Apendicectomía , Neoplasias del Apéndice/historia , Neoplasias del Apéndice/patología , Tumor Carcinoide/historia , Tumor Carcinoide/patología , Niño , Colectomía , Historia del Siglo XIX , HumanosRESUMEN
GOALS: We sought to compare the efficacy and safety of endoscopic ultrasound-guided endoscopic resection (ER) and endoscopic band ligation (EBL) for autoamputation of small duodenal carcinoids. BACKGROUND: The ideal management of small duodenal carcinoid tumors remains unclear. STUDY: A retrospective review of duodenal carcinoids over a 10-year period (2002 to 2012) was performed at our tertiary-care teaching hospital. All patients with duodenal carcinoids ≤10 mm in size treated with either ER or EBL were included. The main outcome measurements were the efficacy and safety of endotherapy. RESULTS: A total of 37 patients with 39 subcentimeter duodenal carcinoids were identified. In the EBL group, the mean (SD) tumor size was 6.7±2.1 mm compared with 6.7±1.7 mm in the ER group (P=0.943). The mean Ki-67 index was ≤2% in specimens available for histologic analysis in both groups (16/23 EBL and 15/16 ER). The positive deep margin rate in the ER group was 68.8%. Residual carcinoid tumor cells were detected on follow-up biopsies in 1 patient after EBL, and 2 patients after ER. All underwent subsequent successful endotherapy. No adverse events occurred in the EBL group compared with an 18.8% adverse event rate in the ER group (P=0.066). CONCLUSIONS: Endoscopic ultrasound-guided EBL is a safe, effective method for removal of small superficial duodenal carcinoids and seems to be a lower risk alternative to conventional ER with cautery.
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Tumor Carcinoide/cirugía , Duodenoscopía/métodos , Neoplasias Intestinales/cirugía , Ligadura/métodos , Adulto , Anciano , Tumor Carcinoide/patología , Duodeno , Femenino , Humanos , Neoplasias Intestinales/patología , Masculino , Persona de Mediana Edad , Neoplasia Residual , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento , Ultrasonografía IntervencionalRESUMEN
Con el objetivo de evaluar el valor pronóstico de la 7a estadificación TNM se analizaron 43 mujeres (61%) y 28 hombres (39%) con diagnóstico de tumor carcinoide tratados quirúrgicamente desde enero/1975 hasta diciembre/2011. Mediana de edad: 38 años (13-67). Presentaron carcinoide típico (CT) 63 (89%) pacientes y 8 (11%) carcinoide atípico (CA). Mediana de seguimiento: 4 años (1 - 24 años). Los estadios correspondientes a CT fueron: IA = 33 (52%), IB = 10 (16%), IIA = 2 (3%), IIB = 2 (3%), IIIA = 12 (19%) y IIIB = 2 (3%); para los CA fueron: IA = 1 (12.5%), IIB = 1 (12.5%), IIIA = 2 (25%) y IIIB = 4 (50%). No hubo diferencia estadísticamente significativa en la supervivencia global a cinco años en el análisis estratificando por estadios (p = 0.689), ni analizando separadamente cada tipo histológico (CT p = 0.547; CA p = 0.592). El intervalo libre de enfermedad fue significativamente menor (CT: 3 años vs CA: 2 años, p = 0.000) y las recaídas más frecuentes en el grupo de carcinoides atípicos (CA: 50% vs CT: 2%, p = 0.000). Los pacientes con CT presentaron buena evolución aun en estadios avanzados, mientras que los que tuvieron CA presentaron menor tiempo de supervivencia e intervalo libre de enfermedad, y mayor frecuencia de recurrencia. El subtipo histológico resultó un factor significativo de pronóstico, mientras que la 7ª estadificación TNM no contribuyó en predecir la supervivencia en los tumores carcinoides.
We analyzed 43 women (61%) and 28 men (39%) surgically treated for carcinoid tumors from Jan/1975 to Dec/2011. Median age: 38 years (13-67). Typical carcinoid (TC) appeared in 63 (89%) patients, 8 (11%) suffered from atypical carcinoid (AC). Median follow-up: 4 years (1-24). TC stages were: IA = 33 (52%), IB = 10 (16%), IIA = 2 (3%), IIB = 2 (3%), IIIA = 12 (19%) and IIIB = 2 (3%); AC stages were: IA = 1 (12.5%), IIB = 1 (12.5%), IIIA = 2 (25%) and IIIB = 4 (50%). TNM classification did not show significant differences on 5-years survival period by stage (p = 0.689), even according to histological type (TC: p = 0.547; AC: p = 0.592). The disease-free survival rate was significantly lower (TC: 3 years vs. AC: 2 years, p = 0.000) and relapses were more frequent in AC (AC: 50% vs. TC: 2%, p = 0.000). The 7th TNM staging was not influential in estimating survival from carcinoid tumours in our population. The histological subtype was a better prognostic factor.