RESUMO
RESUMEN Introducción: El linfoma primario de apéndice ocurre en 0,015% de todas las neoplasias malignas de apéndice. La manifestación clínica más frecuente es apendicitis aguda y el análisis anatomo patológico es muy importante. Reporte de caso: Linfoma primario de apéndice cecal, varón de 38 años, ingresó con apendicitis aguda. Estudio histopatológico macroscópico muestra pared apendicular difusamente engrosada color blanco. Microscópicamente: linfoma de alto grado Burkitt, ACL, CD20, CD10 positivo, KI 67 positivos 95%, CD3, BCL2, EBV negativo. Post operatorio: tomografía abdomino torácica mostró tumoración de fosa iliaca derecha sin lesiones ni adenopatías en abdomen y tórax. El paciente fue tratado con dos cursos de quimioterapia y se le realizó TAC abdominal control a los 6 meses, está evidenció la tumoración inicial. A los 6 meses el paciente se encuentra estable y controlado. Conclusiones: Se enfatiza el valor del estudio histopatológico en los apéndices cecales ante la presencia de linfomas cecales primarios.
ABSTRACT Introduction: Primary lymphoma of the appendix occurs in 0.015% of all malignant neoplasms of the appendix. The most frequent clinical manifestation is acute appendicitis, and pathological analysis is very important. Case report: Primary lymphoma of the cecal appendix, a 38-year-old man was admitted with acute appendicitis. Macroscopic histopathological study shows diffusely thickened white appendage wall. Microscopically: high-grade Burkitt lymphoma, ACL, CD20, CD10 positive, KI 67 positive 95%, CD3, BCL2, EBV negative. Postoperative: thoracic abdominal tomography showed a tumor in the right iliac fossa without lesions or adenopathies in the abdomen and thorax. The patient was treated with two courses of chemotherapy and a control abdominal CT was performed at 6 months, which showed the initial tumor. At 6 months the patient is stable and controlled. Conclusion: The value of the histopathological study in cecal appendages is emphasized in the presence of primary cecal lymphomas.
RESUMO
Primary malignant melanoma of the esophagus is a rare, aggressive and poor-prognostic neoplasm, usually detected in late stages. Surgery (esophagectomy) is the treatment of choice when operable and the only factor that improves the disease prognosis is the detection of the lesions in early stages and the recognition of non-typical lesions. Most commonly, Melanoma lesions appear as large masses with proliferative, ulcerated and pigmented aspect. We report a clinical case whose endoscopic presentation was an elevated, protruding and sessile lesion (Paris Classification Type 0- Is), amelanocytic, size of 4mm, smooth surface, pink and with regular borders (mucosa of tumor with a normal esophagic mucosa appearance). This lesion initially could not be identified because the patient was admitted due to upper gastrointestinal bleeding caused by peptic esophagitis Grade D according to Los Angeles Classification. After histological analysis and immunohistochemistry of the lesion, melanoma was diagnosed. No skin, mucous or ocular lesions were found and multislice spiral computed tomography of thorax and abdomen did not show any metastasis.
Assuntos
Neoplasias Esofágicas/diagnóstico , Melanoma/diagnóstico , Idoso , Humanos , MasculinoRESUMO
Extra-intestinal manifestations of Inflammatory Bowel Disease occur in 25% of cases. Vascular manifestations are rare and occur in 1 to 8% of cases. The most relevant are Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE). They both represent an important cause of morbidity and mortality and increase the risk of DVT recurrence. These are the reasons why prevention and early recognition of these entities are important. There is no agreement yet about the prophylaxis of DVT, neither primary nor secondary, to prevent recurrences in this group of patients. We report the case of a 52 year-old male patient who was admitted due to DVT in the left leg and who was simultaneously diagnosed with Ulcerative Colitis (Truelove activity index:16 points) during this same hospitalization. Doppler ultrasonography of the leg showed a thrombus in the left popliteal vein. Colonoscopy showed nodules, erosions, edema and erythema in the whole colonic mucosa in a continuous fashion. The patient was treated with Sulfazalasine 2gr per day, resulting in total remission of the intestinal complaints, and with Enoxaparin 1.5 IU/Kg per day followed by warfarin 5 mg per day, resulting in disappearance of the popliteal thrombus at 4 weeks. Oral anticoagulant treatment continued for 6 months and no DVT recurrences were seen during follow-up appointments.
Assuntos
Colite Ulcerativa/diagnóstico , Trombose Venosa/etiologia , Colite Ulcerativa/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia , Trombose Venosa/diagnóstico por imagemRESUMO
El Melanoma Maligno Primario de Esófago es una neoplasia muy rara, de comportamiento agresivo y pobre pronostico, generalmente diagnosticada en estadío avanzado. La cirugía (esofagectomía) es el tratamiento de elección cuando es operable por lo que la única manera de mejorar el pronóstico es la identificación de las lesiones en estadios tempranos y el reconocimiento de lesiones no típicas. Generalmente se presentan como masas grandes, de aspecto proliferativo, ulceradas y pigmentadas nosotros presentamos un caso clínico cuya presentación endoscópica fue de una lesión elevada protruida sésil (Clasificación de Paris Tipo 0-Is), amelanocitico de 4 mm de tamaño, con superficie lisa, rosada, bordes regulares (mucosa de tumor con apariencia de mucosa esofágica normal) que inicialmente no pudo ser identificado pues el paciente ingreso por Hemorragia Digestiva Alta debido a esofagitis péptica Los Ángeles D. No se detectaron lesiones cutáneas, en mucosas u oculares. La tomografía espiral multicorte abdomino torácico no mostro metástasis.
Primary malignant melanoma of the esophagus is a rare, aggressive and poor-prognostic neoplasm, usually detected in late stages. Surgery (esophagectomy) is the treatment of choice when operable and the only factor that improves the disease prognosis is the detection of the lesions in early stages and the recognition of non-typical lesions. Most commonly, Melanoma lesions appear as large masses with proliferative, ulcerated and pigmented aspect. We report a clinical case whose endoscopic presentation was an elevated, protruding and sessile lesion (Paris Classification Type 0- Is), amelanocytic, size of 4mm, smooth surface, pink and with regular borders (mucosa of tumor with a normal esophagic mucosa appearance). This lesion initially could not be identified because the patient was admitted due to upper gastrointestinal bleeding caused by peptic esophagitis Grade D according to Los Angeles Classification. After histological analysis and immunohistochemistry of the lesion, melanoma was diagnosed. No skin, mucous or ocular lesions were found and multislice spiral computed tomography of thorax and abdomen did not show any metastasis.
Assuntos
Humanos , Masculino , Idoso , Melanoma , Melanoma Amelanótico , Neoplasias EsofágicasRESUMO
Las manifestaciones extra intestinales en pacientes con Enfermedad Inflamatoria Intestinal (EII) se presentan en un 25% de los casos, de éstas, las manifestaciones vasculares son raras y representan entre el 1% al 8%, las más importantes son la trombosis venosa profunda (TVP) y la embolia pulmonar (EP), representan una causa relevante de morbilidad y mortalidad, además de un mayor riesgo de recurrencia de TVP. Por lo que el reconocimiento y la prevención de estas complicaciones son importantes. No hay consenso aún sobre profilaxis primaria ni secundaria para evitar recurrencias en este tipo de pacientes. Reportamos el caso de un paciente varón de 52 años de edad quien ingresa con cuadro de TVP en vena poplítea izquierda al momento del diagnóstico de Colitis Ulcerativa y durante un episodio de exacerbación severa (Índice de Truelove: 16 puntos). El ecodoppler mostró la presencia de un trombo organizado en vena poplítea izquierda. La colonoscopia mostro en toda la extensión del colon una mucosa nodular, erosionada y tejido edematoso con estenosis parcial, la biopsia reveló Colitis Ulcerativa (CU). El paciente recibió tratamiento con sulfazalasina 2gr/día con remisión de cuadro clínico de CU y anticoagulantes con Enoxaparina 1.5 UI/kg/día al inicio de tratamiento, seguido con Warfarina 5mg/día, con remisión de trombo en vena poplítea a las 4 semanas. Continuó con tratamiento anticoagulante por vía oral por 6 meses no presentando recurrencia de TVP durante el seguimiento de 1,5 años.
Extra-intestinal manifestations of inflammatory Bowel Disease occur in 25% of cases. Vascular manifestations are rare and occur in 1 to 8% of cases. The most relevant are Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE). They both represent an importants cause of morbidity and mortality and increase the risk of DVT recurrence. These are the reasons why prevention and early recognition of these entities are important. There is no agreement yet about the prophylaxis of DVT, neither primary nor secondary, to prevent recurrences in this group of patients. We report the case of a 52 year-old male patient who was admitted due to DVT in the left leg and who was simultaneously diagnosed with Ulcerative Colitis (Truelove activity index:16 points) during this same hospitalization. Doppler ultrasonography of the leg showed a thrombus in the left poplitel vein. Colonoscopy showed nodules, erosions, edema and erythema in the whole colonic mucosa in a continuous fashion. The patient was treated with Sulfazalasine 2gr per day, resulting in total remission of the intestinal complaints, and with Enoxaparin 1.5 IU/Kg per day followed by warfarin 5 mg per day, resulting in disappearance of the popliteal thrombus at 4 weeks. Oral anticoagulant treatment continued for 6 months and no DVT recurrences were seen during follow-up appointments.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Colite Ulcerativa/complicações , Embolia Pulmonar , Trombose VenosaRESUMO
Eosinophilic Gastroentertis (EG) is a very rare disease, characterized by focal or difuse eosinophilic infiltration of the gastrointestinal tract. The clinical presentation is variable and depends on the histological and the extension layer involved. We report a case of eosinophilic gastroenteritis whose main presentation was ascites with peripheral eosinophilia and chronic intermittent diarrhea in a patient with a history of atopy. Upper endoscopy showed severe multifocal erythematous gastritis, the ascitic fluid showed elevated WBC with eosinophilia, with a SAAG (Serum albumin ascites gradient) of less 1.1. The patient was treated with corticoesteroids with remission of clinical manifestation.
Assuntos
Ascite/etiologia , Enterite/complicações , Eosinofilia/complicações , Gastrite/complicações , Adulto , Anti-Inflamatórios/uso terapêutico , Diarreia/etiologia , Enterite/sangue , Enterite/diagnóstico , Enterite/tratamento farmacológico , Enterite/patologia , Eosinofilia/sangue , Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Eosinofilia/etiologia , Eosinofilia/patologia , Feminino , Gastrite/sangue , Gastrite/diagnóstico , Gastrite/tratamento farmacológico , Gastrite/patologia , Humanos , Prednisona/uso terapêuticoRESUMO
La Gastroenteritis Eosinofílica (GE) es una enfermedad muy rara, caracterizándose por infiltrado eosinofílico focal o difusa del tracto gastrointestinal, cuya presentación clínica es muy variable y depende de la capa histológica y la extensión involucrada. Reportamos un caso de gastroenteritis eosinofílica cuya presentación principal fue la ascitis, con eosinofilia periférica y diarrea crónica intermitente en una paciente con historia de atopía. La endoscopia alta mostro gastritis eritematosa severa multifocal, el liquido ascítico mostro leucocitos elevados con eosinofilia, con un GASA (Gradiente albumina sérica liquido ascítico) menor a 1.1. La paciente recibió tratamiento con corticoides con remisión del cuadro clínico.
Eosinophilic Gastroentertis (EG) is a very rare disease, characterized by focal or difuse eosinophilic infiltration of the gastrointestinal tract. The clinical presentation is variable and depends on the histological and the extension layer involved. We report a case of eosinophilic gastroenteritis whose main presentation was ascites with peripheral eosinophilia and chronic intermittent diarrhea in a patient with a history of atopy. Upper endoscopy showed severe multifocal erythematous gastritis, the ascetic fluid showed elevated WBC with eosinophilia, with a SAAG (Serum albumin ascites gradient) of less 1.1 The patient was treated with corticoesteroids with remission of clinical manifestation.