RESUMO
Colorectal cancer is the third most common neoplasm and the second most lethal worldwide. The most common histological type is adenocarcinoma, characterized by its glandular pattern. Medullary colon carcinoma is a rare histological variant of colorectal cancer, characterized by a predominantly solid architecture, poorly di?erentiated or undifferentiated morphology, often associated with an anomalous immunophenotype and microsatellite instability. The present study reports a case in an academic service of general surgery of a 74-year-old patient who presented with a tumor of the ascending colon, histologically with an exuberant lymphocytic in?ltrate, suggestive of large cell lymphoma, but which was revealed by subsequent immunohistochemistry to be medullary carcinoma of the colon with microsatellite instability.
O câncer colorretal é a terceira neoplasia mais comum e a segunda mais letal no mundo. O adenocarcinoma é o tipo histológico mais comum, caracterizado pelo seu padrão glandular. O carcinoma medular do cólon é uma variante histológica rara do câncer colorretal, caracterizada por uma arquitetura predominantemente sólida, morfologia pouco diferenciada ou indiferenciada, frequentemente associada a um imunofenótipo anômalo e instabilidade de microssatélites. O presente estudo relata um caso em um serviço acadêmico de cirurgia geral de um paciente de 74 anos que apresentou tumor de cólon ascendente, histologicamente com infiltrado linfocitário exuberante, sugestivo de linfoma de grandes células, mas que foi revelado através de exame subsequente imunohistoquímico como carcinoma medular do cólon com instabilidade de microssatélites.
Assuntos
Masculino , Idoso , Carcinoma Medular , Colo Ascendente , Oncologia Cirúrgica , Neoplasias do ColoRESUMO
INTRODUCTION: colonoscopy is the best method for detecting polyps, with a reduction in colorectal cancer mortality of 29% and reaching 47% for distal tumors. However, it fails to demonstrate a significant reduction in proximal colon cancer mortality, and is the most common segment with interval neoplasm. The present study aimed to evaluate the impact on detection of polyps of a second sequential evaluation of cecum and ascending colon, with or without the use of indigo carmine chromoendoscopy. METHODS: prospective, non-randomized clinical trial. Patients were divided into two groups. The first (G1) underwent a routine colonoscopy, followed by a second endoscopy assessment of ascending colon and cecum. The second group (G2) underwent a routine colonoscopy, followed by a second assessment of the ascending colon and cecum with indigo carmine chromoendoscopy. RESULTS: In total, 203 patients were analyzed, 101 in the G1 and 102 in the G2. Newer polyps were identified in both groups after the second assessment with a significantly higher number of polyps detected in the patients in the G2 (p=0.0001). The number of patients who had at least one polyp in the two endoscopic assessments was significantly higher in the G2 (53 or 52% vs 27 or 26.7%, p=0.0002). In the second endoscopic assessment, the number of polyps found was also significantly higher in the G2 (50 or 76.9%) compared to the G1 (15 or 23.1%), p<0.0001. CONCLUSIONS: the second assessment with dye-based chromoendoscopy increases the detection of polyps in the ascending colon and cecum.
Assuntos
Adenoma , Pólipos do Colo , Humanos , Colo Ascendente/patologia , Pólipos do Colo/diagnóstico , Pólipos do Colo/patologia , Índigo Carmim , Estudos Prospectivos , Adenoma/diagnóstico , Adenoma/patologia , Colonoscopia , Ceco/patologiaRESUMO
Introducción: La escisión completa del mesocolon con linfadenectomía D3 (CME-D3) mejora los resultados de los pacientes operados por cáncer del colon. Reconocer adecuadamente la anatomía vascular es fundamental para evitar complicaciones. Objetivo: El objetivo primario fue determinar la prevalencia de las variaciones anatómicas de la arteria mesentérica superior (AMS) y sus ramas en relación a la vena mesentérica superior (VMS). El objetivo secundario fue evaluar la asociación entre las distintas variantes anatómicas y el sexo y la etnia de lo pacientes. Diseño: Estudio de corte transversal. Material y métodos: Se incluyeron 225 pacientes con cáncer del colon derecho diagnosticados entre enero 2017 y diciembre de 2020. Dos radiólogos independientes describieron la anatomía vascular observada en las tomografías computadas. Según la relación de las ramas de la AMS con la VMS, la población fue dividida en 2 grupos y subdividida en 6 (1a-c, 2a-c). Resultados: La arteria ileocólica fue constante, transcurriendo en el 58,7% de los casos por la cara posterior de la VMS. La arteria cólica derecha, presente en el 39,6% de los pacientes, cruzó la VMS por su cara anterior en el 95,5% de los casos. La variante de subgrupo más frecuente fue la 2a seguida por la 1a (36,4 y 24%, respectivamente). No se encontró asociación entre las variantes anatómicas y el sexo u origen étnico. Conclusión: Las variaciones anatómicas de la AMS y sus ramas son frecuentes y no presentan un patrón predominante. No hubo asociación entre las mismas y el sexo u origen étnico en nuestra cohorte. El reconocimiento preoperatorio de estas variantes mediante angiotomografía resulta útil para evitar lesiones vasculares durante la CME-D3. (AU)
Background: Complete mesocolic excision with D3 lymphadenectomy (CME-D3) improves the outcomes of patients operated on for colon cancer. Proper recognition of vascular anatomy is essential to avoid complications. Aim: Primary outcome was to determine the prevalence of anatomical variations of the superior mesenteric artery (SMA) and its branches in relation to the superior mesenteric vein (SMV). Secondary outcome was to evaluate the association between these anatomical variations and sex and ethnicity of the patients. Design: Cross-sectional study. Material and methods: Two hundred twenty-fivepatients with right colon cancer diagnosed between January 2017 and December 2020 were included. Two independent radiologists described the vascular anatomy of computed tomography scans. The population was divided into 2 groups and subdivided into 6 groups (1a-c, 2a-c), according to the relationship of the SMA and its branches with the SMV. Results: The ileocolic artery was constant, crossing the SMV posteriorly in 58.7% of the cases. The right colic artery, present in 39.6% of the patients, crossed the SMV on its anterior aspect in 95.5% of the cases. The most frequent subgroup variant was 2a followed by 1a (36.4 and 24%, respectively). No association was found between anatomical variants and gender or ethnic origin. Conclusions: The anatomical variations of the SMA and its branches are common, with no predominant pattern. There was no association between anatomical variations and gender or ethnic origin in our cohort. Preoperative evaluation of these variations by computed tomography angi-ography is useful to avoid vascular injuries during CME-D3. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/cirurgia , Colo Ascendente/anatomia & histologia , Colo Ascendente/irrigação sanguínea , Excisão de Linfonodo , Mesocolo/cirurgia , Argentina , Tomografia Computadorizada por Raios X/métodos , Estudos Transversais , Artéria Mesentérica Superior/anatomia & histologia , Distribuição por Sexo , Colectomia/métodos , Distribuição por Etnia , Variação Anatômica , Veias Mesentéricas/anatomia & histologiaRESUMO
Introducción: La cirugía laparoscópica es una alternativa segura para el tratamiento en el cáncer de colon y además permite todas las ventajas de un procedimiento de mínima invasión. El objetivo de la presente investigación fue medir el impacto en la morbilidad de la técnica quirúrgica abierta vs cerrada en cáncer de colon. Metodología: El estudio se realizó en el Hospital Solón Espinosa Ayala, en Quito-Ecuador, período marzo del 2012 hasta marzo del 2017, con una muestra no probabilística, se incluyeron pacientes mayores de edad, con cáncer de colon. Se incluyen variables socio-demográficas, histología, días de hospitalización, sangrado quirúrgico, tiempo quirúrgico, estancia hospitalaria, márgenes quirúrgicos, ganglios reseca-dos, inicio de dieta, % de conversión quirúrgica, complicación quirúrgica, recidiva, morbilidad quirúrgica, mortalidad quirúrgica. Se utiliza estadística descriptiva univariada y bivariada.Resultados: Se analizan 85casos, 52 casos se realizaron cirugía abierta y 33 casos se realizaron cirugía laparoscópica.La conversión quirúrgica fue 75% por adherencias y 25% por infiltración a duodeno. El tiempo quirúrgico similar 121 a 180 minutos 61%. Complicaciones laparoscópicas 2,3% y 9,4% abierta (colecciones pélvicas y fistulas intestinales 2.4% vs 1.7%). La desnutrición no presentó relación. Inicio de dieta 2 a4 días 83% laparoscópica y 67% abierta. Hospitalización de 4 a 8 días fue laparoscópica 87% y abierta 78%. Pérdida sanguínea menor a 100cc fue laparoscópicas 82%, y abiertas 60%. La resección de ganglios (+13) en laparoscopía 69.6% y abierta 68.1%. El margen proximal de pieza quirúrgica por laparoscopía 5.1 a 10cm (43.5%), por abierta (55.3%), la recaída tumoral del 56.2%y 52.3%. El estado vital por laparoscopía fue fallecido 12.5%, y abierta 28.8%, en relación a su enfermedad tumoral Conclusión: Las comorbilidades quirúrgicas y recuperación fueron menores por laparoscopía, pero la cirugía abierta mostro mejores resultados anatomopatológicos post quirúrgicos
Introduction:Laparoscopic surgery is a safe alternative for colon cancer treatment and allows all the advantages of a minimally invasive procedure. The objective of the present investigation was to measure the impact on morbidity of the open vs. closed surgical technique in colon cancer.Methodology: The study was carried out at the Solón Espinosa Ayala Hospital, in Quito-Ecuador, from March 2012 to March 2017, with a non-probabilistic sample, including elderly patients with colon cancer. Socio-demographic variables, histology, days of hospitalization, surgical bleeding, surgical time, hospital stay, surgical margins, resected lymph nodes, the start of the diet, % surgical conversion, surgical com-plication, recurrence, surgical morbidity, and surgical mortality are included. Univariate and bivariate de-scriptive statistics are used.Results: 85 cases are analyzed; 52 underwent open surgery, and 33 underwent laparoscopic surgery. The surgical conversion was 75% due to adhesions and 25% due to duodenal infiltration. The similar surgical time is 121 to 180 minutes 61%. Laparoscopic complications 2.3% and 9.4% open (pelvic col-lections and intestinal fistulas 2.4% vs 1.7%). Malnutrition was not related. Start of diet 2 to 4 days 83% laparoscopic and 67% open. Hospitalization from 4 to 8 days was laparoscopic 87% and open 78%. Blood loss less than 100cc was laparoscopic in 82% and opened in 60%. Lymph node resection (+13) in lapa-roscopy 69.6% and open 68.1%. The proximal margin of the surgical piece by laparoscopy is 5.1 to 10cm (43.5%), by open (55.3%), the tumor recurrenceof 56.2% and 52.3%. The mortality in laparoscopy surgery was 12.5%, and in open surgery was 28.8%.Conclusion: Laparoscopy's surgical comorbidities and recovery were lower, but open surgery showed better post-surgical pathological results
Assuntos
Neoplasias , Laparoscopia , Colectomia , Colo , Colo Ascendente , Colo DescendenteRESUMO
Introducción: el sarcoma fibromixoide de bajo grado (LGFMS) se considera un tumor de tejidos blandos raro, que tiene tendencia a surgir del tronco y de las extremidades inferiores, su localización en el área intraabdominal se considera poco común. Objetivo: describir un caso de LGFMS primario de colon transverso perforado con metástasis hepática. Caso clínico: describimos el caso de un paciente masculino de 57 años con dolor abdominal de inicio súbito; en la cirugía se encontró un tumor con absceso y perforación en el colon transverso que infiltraba hasta la raíz del mesenterio. Se realizó hemicolectomía izquierda extendida con colostomía de colon ascendente. Más tarde, en una exploración posoperatoria, se encontró que tenía enfermedad hepática metastásica. Conclusiones: este caso es único en términos de ubicación y presentación. Es un recordatorio del diagnóstico diferencial del dolor abdominal agudo. Hasta donde sabemos, es el primer caso de LGFMS del colon con metástasis hepática sincrónica.
Background: Low grade fibromyxoid sarcoma (LGFMS) is considered a rare soft tissue tumor and has a tendency to arise from deep soft tissue of the trunk and lower extremities, the intraabdominal area is considered a rare location. Objective: To describe the first case of a LGFMS arising from the transverse colon with liver metastasis Clinical case: We describe a 57-years-old male patient with abdominal pain of sudden onset; at surgery he was found to have an abscessed tumor in the transverse colon that infiltrated to mesentery root. An extended left hemicolectomy was performed with ascending colon colostomy. Later on, a postoperative scan he was found to have metastatic liver disease Conclusions: This case is unique in terms of the location and presentation. It's a reminder of differential diagnosis of acute abdominal pain. To our knowledge is the first case of a LGFMS of the colon with synchronous liver metastasis.
Assuntos
Humanos , Masculino , Feminino , Neoplasias do Colo , Perfuração Intestinal , Metástase Neoplásica , Sarcoma , Atenção Terciária à Saúde , Colostomia , Dor Abdominal , Colectomia , Colo , Colo Ascendente , HepatopatiasRESUMO
SUMMARY: The normal morphology of the colon differs among mammal species.The ascending colon presents several types of cells, responsible for carrying different functions for this organ. Among them, the mucus-secreting cells ensure the integrity of the mucosa, local defense, protection against different external factors, inflammatory diseases, cancer, etc. The ascending colon from 5 adult male chinchillas were processed for paraffin embedding and stained with three methods: Goldner's trichrome, PAS reaction, and Alcian blue staining procedure. The results showed that the structure of the ascending colon is similar to the one described in other species, i.e. mucosa, submucosa, muscularis externa, and serosa. Regarding the mucus-secreting cells present in the deeper part of the mucosal crypts (deep crypt secretory or DCS cells) turned out to be different not only morphologically from the surface goblet cells but also regarding the type of mucus synthesized. DCS cells have a multivacuolated, faintly stained cytoplasm with moderately PAS-positive reaction and intensely positive reaction to Alcian blue stain. The mean surface of DCS cells was 521.6 μm2 as compared to 437.9 μm2 for goblet cells (p<0.05). In conclusion, our study describes for the first time in chinchilla (Chinchilla lanigera) the presence of formerly known non-goblet or vacuolated cells, and recently entitled DCS cells in the glandular epithelium of the colon. The understanding of morphological peculiarities in chinchilla may serve as a good basis to understand the pathophysiology of various conditions that may arise.
RESUMEN: La morfología normal del colon es diferente entre las especies de mamíferos. El colon ascendente presenta varios tipos de células, encargadas de llevar varias funciones a este órgano. Entre ellos, las células secretoras aseguran la integridad de la mucosa, defensa local, protección frente a diferentes factores externos, enfermedades inflamatorias, cáncer, etc. Se procesaron para su inclusión en parafina el colon ascendente de 5 chinchillas machos adultos y se tiñeron con tres métodos: tricrómico de Goldner, reacción PAS y Azul de Alcian. Los resultados mostraron que la estructura de del colon ascendente es similar a la descrita en otras especies, es decir, mucosa, submucosa, muscular externa y serosa. Las células secretoras de la mucosa presente en la parte más profunda de las criptas mucosas (células secretoras de la cripta profunda o células DCS) resultaron ser diferentes morfológicamente de las células caliciformes superficiales, con citoplasma levemente teñido con reacción PAS positiva moderada y reacción intensamente positiva a Azul de Alcian. La superficie media de las células DCS fue de 521,6 μm2 en comparación con 437,9 μm2 de las células caliciformes (p <0,05). En conclusión, nuestro estudio describe por primera vez en chinchilla (Chinchilla lanigera) la presencia de células no caliciformes o vacuoladas anteriormente conocidas, y recientemente denominadas células DCS en el epitelio glandular del colon. La comprensión de las peculiaridades morfológicas de la chinchilla puede servir como una buena base para comprender la fisiopatología de las diversas afecciones.
Assuntos
Animais , Chinchila/anatomia & histologia , Colo Ascendente/citologiaRESUMO
OBJECTIVE: To provide guidance for the management of RAS wild-type (wt) metastatic colorectal cancer (mCRC) in daily practice. METHODS: Nominal group and Delphi techniques were used. A steering committee of seven experts analyzed the current management of RAS wt mCRC, through which they identified controversies, critically analyzed the available evidence, and formulated several guiding statements for clinicians. Subsequently, a group of 30 experts (the expert panel) was selected to test agreement with the statements, through two Delphi rounds. The following response categories were established in both rounds: 1 = totally agree, 2 = basically agree, 3 = basically disagree, 4 = totally disagree. Agreement was defined if ≥ 75% of answers were in categories 1 and 2 (consensus with the agreement) or 3 and 4 (consensus with the disagreement). RESULTS: Overall, 71 statements were proposed, which incorporated the following areas: (1) overarching principles; (2) tumor location; (3) triplets; (4) maintenance; (5) second-line and beyond treatments; (6) Rechallenge and liquid biopsy. After the two Delphi rounds, only six statements maintained a lack of clear consensus. CONCLUSIONS: This document aims to describe the expert's attitude when dealing with several common clinical questions regarding patients with RAS wt mCRC.
Assuntos
Comitês Consultivos , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/genética , Consenso , Técnica Delphi , Genes ras/genética , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/uso terapêutico , Camptotecina/análogos & derivados , Camptotecina/uso terapêutico , Colo Ascendente/patologia , Colo Transverso/patologia , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/genética , Neoplasias do Colo/patologia , Neoplasias Colorretais/patologia , Receptores ErbB/antagonistas & inibidores , Fluoruracila/uso terapêutico , Genótipo , Humanos , Leucovorina/uso terapêutico , Biópsia Líquida , Quimioterapia de Manutenção/métodos , Compostos Organoplatínicos/uso terapêutico , Proteínas Proto-Oncogênicas B-raf/genética , RetratamentoRESUMO
RESUMEN Se presenta el caso de un paciente con cáncer de colon ascendente e infiltración de la pared abdominal con tumoración proliferativa sobre la piel. Se trata de un varón de 83 años que diez meses antes de su ingreso fue operado por un absceso intraabdominal y evoluciona con una fistula colocutánea. El paciente presentaba una tumoración en flanco y fosa iliaca derecha, de 10 cm de diámetro, proliferativa, multilobulada, no dolorosa; a la biopsia resultó adenocarcinoma. La colonoscopía reveló tumoración de 6 cm en colon ascendente, la biopsia reportó adenocarcinoma medianamente diferenciado. La tomografía mostró una lesión neoformativa en colon ascendente y región cecal con dimensiones de 52x46x44 mm con un trayecto tumoral colocutáneo de 62 mm que terminaba a nivel cutáneo en una lesión ovoide de 70 mm. Se realizó colectomía derecha con resección en bloque de la pared abdominal comprometida por la tumoración. Se postula la relación entre la infiltración cutánea, y el antecedente de drenaje quirúrgico laparoscópico de un absceso intraperitoneal aparentemente causado como una complicación del cáncer de colon ascendente casi un año antes del ingreso. El drenaje utilizado sirvió de ruta para la infiltración a la pared abdominal.
ABSTRACT The case of a patient with ascending colon cancer and infiltration of the abdominal wall with a proliferative tumor on the skin is presented. This is an 83-year-old man who underwent surgery for an intra-abdominal abscess ten months before admission and develops a colocutaneous fistula. The patient presented a 10 cm diameter proliferative, multilobed, non-painful tumor on the flank and right iliac fossa; the biopsy revealed an adenocarcinoma. The colonoscopy revealed a 6 cm tumor in the ascending colon, the biopsy reported moderately differentiated adenocarcinoma. The tomography showed a neoformative lesion in the ascending colon and cecal region with dimensions of 52x46x44 mm with a 62 mm colocutaneous tumor course that ended at the cutaneous level in a 70 mm ovoid lesion. A right colectomy was performed with en bloc resection of the abdominal wall compromised by the tumor. The relationship between skin infiltration and a history of laparoscopic surgical drainage of an intraperitoneal abscess apparently caused as a complication of ascending colon cancer almost one year before admission is postulated. The drain used served as a route for infiltration into the abdominal wall.
Assuntos
Idoso de 80 Anos ou mais , Humanos , Masculino , Neoplasias do Colo , Parede Abdominal , Colonoscopia , Colectomia , Neoplasias do Colo/cirurgia , Neoplasias do Colo/diagnóstico , Parede Abdominal/cirurgia , Colo Ascendente/cirurgiaRESUMO
RESUMEN El cáncer colorrectal (CCR) es el tercer cáncer más frecuente en el mundo y la segunda causa de muerte de origen neoplásico. El sincronismo en CCR es de aproximadamente 3-6%. El tracto gastrointestinal es el lugar más frecuente de asiento de neoplasias neuroendocrinas (NNE), y de estos los carcinomas neuroendocrinos (CNE) son poco frecuentes. El tratamiento es un desafío, debido a la agresividad de la neoplasia y la falta de protocolos bien establecidos. Todo esto conlleva a la necesidad de un enfoque multidisciplinario, sin embargo, en la mayoría de casos el pronóstico resulta no ser el mejor. Presentamos el caso de un varón de 83 años que acude a emergencia con historia de 3 meses de diarrea, dolor perianal, pérdida ponderal y hematoquezia. El estudio endoscópico evidenció dos neoplasias y el estudio histológico confirmó la presencia de CNE de células pequeñas de recto y adenocarcinoma de colon ascendente, recibió quimioterapia sistémica sin embargo evolucionó desfavorablemente falleciendo a las 3 semanas.
ABSTRACT Colorectal cancer (CRC) is the third most frequent cancer in the world and the second cause of death of neoplastic origin. Synchronism in CCR is approximately 3-6%. The gastrointestinal tract is the most frequent place where neuroendocrine neoplasms (NNE) settle and a special type of these neuroendocrine carcinomas (CNE) are rare. Treatment is challenging, due to the aggressiveness of the malignancy and the lack of well-established protocols. Therefore a multidisciplinary approach is needed, however, in most cases the result is not the best. We present the case of an 83-year-old man who has an emergency with a 3-month history of diarrhea, perianal pain, weight loss, and hematochezia. The endoscopic study shows evidence of two malignancies and the histological study confirms the presence of CNE in small cells at the rectum and adenocarcinoma in the ascending colon. He underwent systematic chemotherapy, however, he evolved unfavorably, dying after 3 weeks.
Assuntos
Idoso de 80 Anos ou mais , Humanos , Masculino , Adenocarcinoma , Neoplasias do Colo , Carcinoma Neuroendócrino , Reto , Adenocarcinoma/diagnóstico , Neoplasias do Colo/diagnóstico , Carcinoma Neuroendócrino/diagnóstico , Colo AscendenteRESUMO
RESUMEN Introducción: El cáncer avanzado es aquel que crece fuera del órgano en el cual se originó. La resección quirúrgica es el método más eficaz para lograr la curación de cáncer colorrectal en 50 por ciento de los casos. Objetivo: Evaluar los resultados del tratamiento multidisciplinar, realizado a pacientes con diagnóstico de cáncer colorrectal avanzado. Método: Se realizó un estudio observacional, descriptivo, ambispectivo y de corte transversal en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras" entre enero de 2013 y diciembre de 2018. La muestra fue de 219 casos. Resultados: El 34,2 por ciento de los pacientes tenían entre 70 y 79 años. Hubo predominio de localización en colon ascendente (37,4 por ciento), en 57,1 por ciento fue moderadamente diferenciado y en 34,2 por ciento en estadio IIIA. El 7,8 por ciento de los pacientes tuvo recaída con metástasis, de ellos, 70,5 por ciento en hígado. En 72,6 por ciento la vía de acceso fue laparoscópica. En 50,7 por ciento se realizó hemicolectomía derecha. Las complicaciones se observaron en 25 pacientes (35,2 por ciento). El 91,3 por ciento de los casos recibió terapia adyuvante. En 27,4 por ciento hubo recurrencia. En el análisis del tiempo libre de enfermedad y de la supervivencia se obtuvieron buenos resultados. Conclusiones: El tratamiento combinado, secuencial y multidisciplinario en enfermedad maligna colorrectal avanzada ha demostrado beneficios clínicos y mayor supervivencia. Con una morbilidad y mortalidad relacionada con el proceder quirúrgico aceptable independientemente la vía de acceso empleada(AU)
ABSTRACT Introduction: advanced cancer is cancer that has grown outside the organ in which it originated. Surgical resection is the most effective method to achieve colorectal cancer cure in 50 % of cases. Objectives: the objective was to evaluate the results of the multidisciplinary treatment, carried out on patients diagnosed with advanced colorectal cancer. Method: it is an observational, descriptive, ambispective and cross-sectional study at the "Hermanos Ameijeiras" Surgical Clinical Hospital between January 2013 and December 2018. The sample was 219 cases. Results: 34.2 percent of the patients were between 70 and 79 years old. 56.2 percent were women. There was a predominance of localization in the ascending colon (37.4 percent), in 57.1 percent it was moderately differentiated and in 34.2 percent in stage IIIA. 7.8 percent of the patients had a metastatic relapse, 70.5 percent of them in the liver. In 72.6 percent, the access route was laparoscopic. Right hemicolectomy was performed in 50.7 percent. Complications were observed in 25 patients (35.2 percent). 91.3 percent of the cases received adjuvant therapy. In 27.4 percent there was recurrence. Good results were obtained in the analysis of disease-free time and survival. Conclusion: we conclude that combined, sequential, and multidisciplinary treatment in advanced colorectal malignancy has demonstrated clinical benefits and increased survival. With an acceptable morbidity and mortality related to the surgical procedure regardless of the access route used. Multivisceral and / or en bloc resections and maximum resection manage to increase the free interval of disease progression and alleviate symptoms(AU)
Assuntos
Humanos , Masculino , Feminino , Idoso , Neoplasias Colorretais/diagnóstico , Colectomia/métodos , Colo Ascendente/lesões , Metástase Neoplásica/tratamento farmacológico , Epidemiologia Descritiva , Estudos Transversais , Estudos Observacionais como AssuntoRESUMO
The case of a patient with ascending colon cancer and infiltration of the abdominal wall with a proliferative tumor on the skin is presented. This is an 83-year-old man who underwent surgery for an intra-abdominal abscess ten months before admission and develops a colocutaneous fistula. The patient presented a 10 cm diameter proliferative, multilobed, non-painful tumor on the flank and right iliac fossa; the biopsy revealed an adenocarcinoma. The colonoscopy revealed a 6 cm tumor in the ascending colon, the biopsy reported moderately differentiated adenocarcinoma. The tomography showed a neoformative lesion in the ascending colon and cecal region with dimensions of 52x46x44 mm with a 62 mm colocutaneous tumor course that ended at the cutaneous level in a 70 mm ovoid lesion. A right colectomy was performed with en bloc resection of the abdominal wall compromised by the tumor. The relationship between skin infiltration and a history of laparoscopic surgical drainage of an intraperitoneal abscess apparently caused as a complication of ascending colon cancer almost one year before admission is postulated. The drain used served as a route for infiltration into the abdominal wall.
Assuntos
Parede Abdominal , Neoplasias do Colo , Parede Abdominal/cirurgia , Idoso de 80 Anos ou mais , Colectomia , Colo Ascendente/cirurgia , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/cirurgia , Colonoscopia , Humanos , MasculinoRESUMO
Colorectal cancer (CRC) is the third most frequent cancer in the world and the second cause of death of neoplastic origin. Synchronism in CCR is approximately 3-6%. The gastrointestinal tract is the most frequent place where neuroendocrine neoplasms (NNE) settle and a special type of these neuroendocrine carcinomas (CNE) are rare. Treatment is challenging, due to the aggressiveness of the malignancy and the lack of well-established protocols. Therefore a multidisciplinary approach is needed, however, in most cases the result is not the best. We present the case of an 83-year-old man who has an emergency with a 3-month history of diarrhea, perianal pain, weight loss, and hematochezia. The endoscopic study shows evidence of two malignancies and the histological study confirms the presence of CNE in small cells at the rectum and adenocarcinoma in the ascending colon. He underwent systematic chemotherapy, however, he evolved unfavorably, dying after 3 weeks.
Assuntos
Adenocarcinoma , Carcinoma Neuroendócrino , Neoplasias do Colo , Adenocarcinoma/diagnóstico , Idoso de 80 Anos ou mais , Carcinoma Neuroendócrino/diagnóstico , Colo Ascendente , Neoplasias do Colo/diagnóstico , Humanos , Masculino , RetoRESUMO
RESUMEN El síndrome de Waugh es una patología del neonato caracterizado por la asociación de una malrotación intestinal a una intususcepción. Existen pocos casos documentados en la literatura, lo que conlleva una baja incidencia. Presentamos el caso de un neonato femenino de 4 meses de edad quien fue llevada a tratamiento quirúrgico con oclusión intestinal y evolución posoperatoria favorable. El objetivo del trabajo es presentar el caso de un síndrome de Waugh en un lactante en cuyo cuadro se debe mantener una alta sospecha diagnostica, apoyándose con la toma de estudios de imagen complementarios ante un cuadro de dolor abdominal en pacientes lactantes cuya resolución diagnostica siempre resulta un reto para el médico. Si bien estas acciones podrán en un futuro reflejar un aumento en la incidencia de este síndrome, también es posible que el manejo de dicho síndrome se optimice. Paciente femenina de 4 meses de edad la cual fue sometida a tres intentos de desinvaginación hidrostática antes de pasar a laparotomía exploradora para corrección definitiva de su patología. La asociación de invaginación con mal rotación intestinal actualmente es subdiagnósticada, debido a la tendencia conservadora actual. Es importante realizar más estudios de imagen antes de iniciar con cualquier estrategia terapéutica, para no retrasar el manejo quirúrgico definitivo que este requiere. De esta manera se podrá ganar en la calidad de los pronósticos de los pacientes(AU)
ABSTRACT Waugh's syndrome is a neonatal pathology characterized by the association of intestinal malrotation and intussusception. There is a low number of cases documented in literature, which implies low incidence. Here is a 4 months-old female neonate who was surgically treated because of intestinal occlusion, and her postoperative recovery was favorable. The objective was to present a Waugh's syndrome case in a newborn in which high diagnostic suspicion is important, supported by complementary imaging studies when we face abdominal pain in neonates whose diagnostic resolution is always a challenge to the physician. These actions may show an increase in the incidence of this syndrome in the future; it is also possible that the management of this disease be optimized. Hydrostatic disinvagination was performed three times in this patient before undergoing exploratory laparotomy for final correction of her pathology. The association of invagination and intestinal malrotation is poorly diagnosed at present, due to current conservative tendencies. However, it is important to perform more imaging studies before adopting any therapeutic strategy to avoid delays in the definitive surgical management of this disease(AU)
Assuntos
Humanos , Feminino , Lactente , Apendicectomia/efeitos adversos , Colo Ascendente/anormalidades , Intussuscepção/diagnóstico , Laparotomia/métodosAssuntos
Fístula Biliar/complicações , Colangite/etiologia , Doenças do Colo/complicações , Cálculos Biliares/complicações , Fístula Intestinal/complicações , Fístula Biliar/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica , Colecistite/etiologia , Doença Crônica , Colo Ascendente , Doenças do Colo/diagnóstico por imagem , Cálculos Biliares/diagnóstico por imagem , Humanos , Fístula Intestinal/diagnóstico por imagem , Masculino , Pessoa de Meia-IdadeRESUMO
Aging can promote significant morphofunctional changes in the gastrointestinal tract (GIT). Regulation of GIT motility is mainly controlled by the myenteric neurons of the enteric nervous system. Actions that aim at decreasing the aging effects in the GIT include those related to diet, with caloric restriction (CR). The CR is achieved by controlling the amount of food or by manipulating the components of the diet. Therefore, the objective of this study was to evaluate different levels of CR on the plasticity of nicotinamide adenine dinucleotide phosphate- (NADPH-) reactive myenteric neurons in the colon of Wistar rats during the aging process using ultrastructural (transmission electron microscopy) and morphoquantitative analysis. Wistar male rats (Rattus norvegicus) were distributed into 4 groups (n = 10/group): C, 6-month-old animals; SR, 18-month-old animals fed a normal diet; CRI, 18-month-old animals fed a 12% CR diet; CRII, 18-month-old animals fed a 31% CR diet. At 6 months of age, animals were transferred to the laboratory animal facility, where they remained until 18 months of age. Animals of the CRI and CRII groups were submitted to CR for 6 months. In the ultrastructural analysis, a disorganization of the periganglionar matrix with the aging was observed, and this characteristic was not observed in the animals that received hypocaloric diet. It was observed that the restriction of 12.5% and 31% of calories in the diet minimized the increase in density and cell profile of the reactive NADPH neurons, increased with age. This type of diet may be adapted against gastrointestinal disturbances that commonly affect aging individuals.
Assuntos
Envelhecimento , Restrição Calórica , Colo/inervação , Gânglios Autônomos/crescimento & desenvolvimento , Plexo Mientérico/crescimento & desenvolvimento , Plasticidade Neuronal , Neurônios Nitrérgicos/fisiologia , Animais , Biomarcadores/metabolismo , Contagem de Células , Colo/crescimento & desenvolvimento , Colo/fisiologia , Colo/ultraestrutura , Colo Ascendente/crescimento & desenvolvimento , Colo Ascendente/inervação , Colo Ascendente/fisiologia , Colo Ascendente/ultraestrutura , Colo Descendente/crescimento & desenvolvimento , Colo Descendente/inervação , Colo Descendente/fisiologia , Colo Descendente/ultraestrutura , Gânglios Autônomos/citologia , Gânglios Autônomos/fisiologia , Gânglios Autônomos/ultraestrutura , Masculino , Microscopia Eletrônica de Transmissão , Plexo Mientérico/citologia , Plexo Mientérico/fisiologia , Plexo Mientérico/ultraestrutura , NADPH Desidrogenase/metabolismo , Proteínas do Tecido Nervoso/metabolismo , Neuroproteção , Neurônios Nitrérgicos/citologia , Neurônios Nitrérgicos/ultraestrutura , Tamanho do Órgão , Especificidade de Órgãos , Ratos WistarRESUMO
Human schistosomiasis is an important neglected tropical disease caused by blood flukes of the genus Schistosoma and is responsible for more than 280,000 deaths annually. Treatment for this disease relies currently on a single drug, praziquantel (PZQ). Concerns regarding PZQ resistance and insensitivity of juvenile schistosomes have increased the interest in resorting to medicinal plants for alternative drug therapies. This study aimed to perform an in vivo schistosomicidal activity evaluation of crude hexanic (HE) and ethanolic (EE) extracts obtained from Phyllanthus amarus in mice infected with Schistosoma mansoni (BH strain). Mice were treated orally with a single dose of 100 or 250 mg/kg, on two different infection periods, 30 and 45 days post-infection (dpi). Parameters such as worm recovery, faecal egg count, intestinal tissue egg count and liver histopathology were evaluated. Treatment against young adult (30 dpi) and adult (45 dpi) worms were more effective compared to the control group treated with PZQ. At a concentration of 250 mg/kg (30 dpi) EE showed a 54.4% female reduction and a 61.2% total worm reduction whilst at a concentration of 100 mg/kg (45 dpi) HE showed a 40.6% female worm reduction and a 45.3% total worm reduction. Histopathological examination showed a granuloma decrease in both number and size for groups treated with 250 mg/kg of HE (45 dpi) or EE (30 or 45 dpi). From these results, it can be concluded that both hexanic and ethanolic extracts have antischistosomal activities, however, act differently according to the parasites age. The schistosomicidal activity results in groups treated 30 days post infection is extremely important since praziquantel does not show activity against the juvenile forms of Schistosoma.
Assuntos
Anti-Helmínticos/farmacologia , Phyllanthus/química , Extratos Vegetais/farmacologia , Schistosoma mansoni/efeitos dos fármacos , Esquistossomose mansoni/tratamento farmacológico , Animais , Anti-Helmínticos/uso terapêutico , Biomphalaria , Colo Ascendente/parasitologia , Etanol , Fezes/parasitologia , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Hexanos , Fígado/patologia , Camundongos , Contagem de Ovos de Parasitas , Extratos Vegetais/uso terapêutico , Praziquantel/farmacologia , Praziquantel/uso terapêutico , Esquistossomose mansoni/parasitologia , SolventesRESUMO
Toxoplasmosis, a disease caused by Toxoplasma gondii, is an important health problem, especially in immunocompromised hosts. T. gondii uses the gut wall as an infection gateway, with tropism for muscular and nervous tissues causing intestinal alterations, including some in the enteric nervous system. This study aims at investigating the colon of rats infected by T. gondii in order to understand how the amount of oocysts influences in myenteric neuronal changes. Sixty Wistar rats (Rattus norvegicus) were divided into six groups. One group remained as a control and the others received inocula of 10, 50, 100, 500 or 5,000 oocysts of T. gondii. The animals were euthanized after 30 days of infection. The total neuronal population and the nitrergic subpopulation in the colon myenteric plexus of each animal was counted. The data were statistically analyzed showing less weight gain in rats with 10, 500 and 5,000 oocysts. A decrease in the number of total neurons with 50, 100 or 5,000 oocysts and an increase in the nitrergic population with 10, 100, 500 or 5,000 oocysts were verified. These results show that neuronal alterations are more significant when the infection is induced by larger inocula and reinforces the suspicion that neuronal loss is directed at cholinergic neurons.(AU)
A toxoplasmose, doença causada pelo Toxoplasma gondii, é um importante problema de saúde, principalmente em imunocomprometidos. T. gondii utiliza a parede do intestino como porta de entrada no hospedeiro e tem tropismo pelos tecidos muscular e nervoso provocando alterações intestinais, inclusive no sistema nervoso entérico. Este estudo buscou analisar o cólon de ratos infectados por T. gondii para entender como a quantidade de oocistos influencia nas alterações neuronais mientéricas. Foram utilizados 60 ratos Wistar (Rattus norvegicus) em seis grupos. Um dos grupos permaneceu como controle e os demais receberam inóculos de 10, 50, 100, 500 ou 5.000 oocistos de T. gondii. Os animais foram submetidos a eutanásia após 30 dias de infecção. No plexo mientérico do cólon dos animais foram quantificadas a população neuronal total e a subpopulação nitrérgica. Os dados foram analisados estatisticamente demonstrando inferior ganho de peso nos ratos com 10, 500 e 5.000 oocistos. Verificamos diminuição no número de neurônios totais com inóculos de 50, 100 ou 5.000 oocistos e aumento da população nitrérgica com 10, 100, 500 ou 5000 oocistos. Estes resultados mostram que alterações neuronais são mais significativas quando a infecção é induzida por inóculos maiores e reforça a suspeita de perda neuronal direcionada a neurônios colinérgicos.(AU)
Assuntos
Animais , Ratos , Toxoplasmose Cerebral/imunologia , Toxoplasmose Cerebral/prevenção & controle , Toxoplasmose Cerebral/parasitologia , Toxoplasmose Cerebral/veterinária , Oocistos/imunologia , Oocistos/parasitologia , Colo Ascendente/imunologia , Colo Ascendente/parasitologia , Plexo Mientérico/lesões , Plexo Mientérico/fisiologia , Plexo Mientérico/parasitologia , Neurônios/imunologia , Neurônios/fisiologia , Neurônios/parasitologiaRESUMO
Abstract In this article we present a rare variant in which the large intestine was vascularized by the inferior mesenteric artery. It was encountered during macro and microscopic dissection of the cadaver of a 63-year-old woman at a university department of human anatomy. In this case, the ascending, transverse, descending, and sigmoid colon and rectum were vascularized by the inferior mesenteric artery, whereas the small intestine, cecum and appendix were supplied by the superior mesenteric artery.
Resumo Neste artigo apresentamos uma variação rara em que o intestino grosso era vascularizado pela artéria mesentérica inferior. A variação foi descoberta durante a dissecção macro e microscópia de um cadáver do sexo feminino, 63 anos de idade, em um departamento universitário de anatomia humana. Neste caso, o cólon ascendente, transverso, descendente e sigmoide e também o reto eram vascularizados pela artéria mesentérica inferior, ao passo que o intestino delgado, ceco e apêndice eram vascularizados pela artéria mesentéria superior.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Intestino Grosso/anatomia & histologia , Artéria Mesentérica Inferior/anatomia & histologia , Anatomia , Colo Ascendente/anatomia & histologia , Dissecação/métodos , Intestino Delgado/anatomia & histologia , Artéria Mesentérica Superior/anatomia & histologiaRESUMO
BACKGROUND: Colonoscopy is part of the current diagnostic armamentarium. However, in some patients with chronic diarrhea, a colonoscopy may show normal mucosa; in these cases, serial biopsies can provide important information for the diagnosis and treatment of patients. AIM: To analyze patients with chronic diarrhea having a macroscopically normal colonoscopy, by evaluating histological changes. METHODS: 30 patients with chronic diarrhea and normal colonoscopy were prospectively evaluated and submitted to serial biopsies of the terminal ileum, ascending colon and rectum. RESULTS: The sample of 30 patients showed a ratio of 18 men (60%) and 12 women (40%). On histological types, it was found that 13 patients (43.3%) had lymphoid hyperplasia, eosinophilic inflammation in 4 (13.3%), nonspecific inflammation in 4 (13.3%), regenerative changes in 3 (10%), lymphocytic colitis in 2 (6.6%) and changes consistent with Crohn's disease in 1 (3.3%). CONCLUSIONS: One can observe that even chronic diarrhea patients, without other associated factors, benefited from colonoscopy with biopsy, because it held the etiologic diagnosis in some cases as also excluded by histopathology. It was noticed that the frequency of patients with altered biopsy and less dragged diarrheal episodes (84.2%) was large, should consider their achievement.
INTRODUÇÃO: A colonoscopia faz parte do arsenal de diagnóstico atual. Porém, em alguns pacientes com diarreia crônica, a colonoscopia pode evidenciar mucosa normal; nesses casos biópsias seriadas podem trazer informações importantes para o diagnóstico e tratamento dos pacientes. OBJETIVO: Analisar pacientes com diarreia crônica submetidos à colonoscopia macroscopicamente normal, avaliando assim histologicamente as alterações. MÉTODOS: Análise prospectiva da histologia 30 pacientes com diarreia crônica e colonoscopias normais, submetidos a biópsias seriadas de íleo terminal, cólon ascendente e reto. RESULTADOS: A amostra de 30 pacientes mostrou uma proporção de 18 homens (60%) e 12 mulheres (40%). Sobre os tipos de alterações histológicas, foi verificado que 13 pacientes (43,3%) apresentaram hiperplasia linfóide, inflamação eosinofílica em 4 (13,3%), inflamação inespecífica em 4 (13,3%), alterações regenerativas em 3 (10%), colite linfocítica em 2 (6,6%) e alterações compatíveis com Doença de Crohn em 1 (3,3%). CONCLUSÕES: Observou-se que mesmo pacientes com diarreia crônica, sem outros fatores associados, beneficiaram-se da colonoscopia com biópsia, pois a mesma realizou o diagnóstico etiológico em alguns casos como também o excluiu através da histopatologia. Verificou-se que a frequência de pacientes com biópsia alterada e quadros diarreicos menos arrastados (84,2%) foi grande, devendo-se considerar a realização do exame.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Reto/cirurgia , Doença de Crohn/cirurgia , Pseudolinfoma , Colo Ascendente/cirurgia , Diarreia/diagnóstico , Diarreia/patologia , Reto/patologia , Doença de Crohn/patologia , Colonoscopia , Colo Ascendente/patologia , Colite Linfocítica , Diarreia/microbiologia , InflamaçãoRESUMO
As hérnias pelo forame de Winslow fazem parte de uma condição extremamente rara, compreendendo apenas 0,08% de todas as hérnias já descritas. O diagnóstico pré-operatório dessa afecção é infrequente (menos de 10% das vezes) e por isso atinge altas taxas de mortalidade, em torno de 36% a 49% dos casos. Apresentamos o caso de paciente, 92 anos, sexo feminino, com quadro de náuseas, vômitos, dor e distensão abdominal de rápida evolução sem melhora ao tratamento clínico, caracterizando diagnóstico sindrômico de abdome agudo obstrutivo. Exames laboratoriais e de imagem foram pouco elucidativos, sendo indicado uma abordagem cirúrgica por meio de uma laparotomia exploradora. Os achados cirúrgicos definiram o diagnóstico etiológico de encarceramento do ceco e cólon ascendente na retrocavidade através do forame de Winslow. O quadro clínico dessa afecção é muito variável, refletindo sintomas de acordo com o conteúdo herniado e o tempo de evolução. Trata-se de uma patologia de difícil suspeição, sendo que o diagnóstico definitivo é geralmente realizado durante o ato operatório. A lembrança dessa hipótese diagnóstica como diagnóstico diferencial de quadros de abdomes agudos oclusivos deve ser adequadamente pensada para que se possa propor o melhor e mais específico tratamento, a fim de se evitar maiores complicações de um diagnóstico tardio.
Herniations through foramen of Winslow are part of a extremely rare condition, establishing only 0.08% of all descripted hérnias. The pre operative diagnosis is uncommon (less than 10%) and this condition allows mortality rates to reach high levels, beetween 36 to 49% of the cases. The presente case reports a 92 years of age woman, presenting náuseas, vomits, distension and abdominal pain, persisting through hours with no positive response to clinical treatment, this way featuring an abdominal urgency syndrom. Laboratorial e image exams had no great findings; surgical treatment was so proposed. Surgical findings have defined the condition as being a cécum and ascending colon herniation through foramen of Winslow in retrocavity. Clinical findings of this condition are variable, reflecting sympthons of which content is herniated as well as duration of the herniation process. It is a hard suspicion patology, as most of the cases diagnosis are made during the surgery, only. The knowledge about this diagnosis hypothesys may be of great importance while maneging abdominal pain patients, this way porpousing best exams procedures and precocious treatment, avoiding late diagnosis complications.