Metachronic malignant transformation of small bowel and rectal endometriosis in the same patient

[ES] Background: Malignant transformation of intestinal endometriosis is a rare event with an unknown rate of incidence. Metachronous progression of endometriosis to adenocarcinoma from two distant intestinal foci happening in the same patient has not been previously reported. Case presentation: We describe a case of metachronic transformation of ileal and rectal endometriosis into an adenocarcinoma occurring in a 45-year-old female without macroscopic pelvic involvement of her endometriosis. First, a right colectomy was performed due to intestinal obstruction by an ileal mass. Pathological examination revealed an ileal endometrioid adenocarcinoma and contiguous microscopic endometriotic foci. Twenty months later, a rectal mass was discovered. An endoscopic biopsy revealed an adenocarcinoma. En bloc anterior rectum resection, hysterectomy and bilateral salpingectomy were performed. A second endometrioid adenocarcinoma arising from a focus of endometriosis within the wall of the rectum was diagnosed. Conclusion: Intestinal endometriosis should be considered a premalignant condition in premenopausal women.

Intrinsic ordering, combinatorial numbers and reliability engineering

[EN]A new algorithm for evaluating the top event probability of large fault trees (FTs) is presented. This algorithm does not require any previous qualitative analysis of the FT. Indeed, its efficiency is independent of the FT logic, and it only depends on the number n of basic system components and on their failure probabilities. Our method provides exact lower and upper bounds on the top event probability by using new properties of the intrinsic order relation between binary strings. The intrinsic order enables one to select binary n-tuples with large occurrence probabilities without necessity to evaluate them. This drastically reduces the complexity of the problem from exponential (2n binary n-tuples) to linear (n Boolean variables)...