Adenocarcinoma of the Ileum: A Rare and Challenging Entity

INTRODUCTION: Primary small bowel malignancy is unusual and accounts for 1-3% of all gastrointestinal tract neoplasms. Adenocarcinoma is one of the most common histologic types, but its frequency decreases with more distal locations. Its clinical presentation is nonspecific and is usually associated with advanced disease, which contributes to delayed diagnosis. PRESENTATION OF CASE: A 66-year-old woman was admitted to the hospital with a 6-day history of progressively worsening abdominal pain localized in the right lower quadrant, nausea, and vomiting. Investigation revealed an inflammatory appendiceal tumor. The patient underwent surgery and an unexpected tumor involving the distal ileal segment and ileocecal appendix was found. Right radical hemicolectomy with en bloc resection of the distal ileum was performed. Histopathological examination revealed adenocarcinoma of the ileum. DISCUSSION: This rare entity is associated with a nonspecific clinical presentation that contributes to delayed diagnosis and treatment, and consequently to a worse prognosis. Approximately half of the cases are only diagnosed at surgery. Primary treatment consists of wide resection with locoregional lymphadenectomy. The role of adjuvant chemotherapy has yet to be determined. CONCLUSION: This case demonstrates an unusual condition characterized by late and challenging diagnosis. We highlight the importance of an earlier diagnosis and optimal treatment for improved patient outcomes.

Complete loss of vision caused by a giant mucocele of the frontal sinus.

The authors report the case of a 75-year-old man presenting with an exceptionally large giant posttraumatic mucocele of the frontal sinus years after a gunshot blast to the head. The lesion had grown so extensively that the right eye had shrunk and calcified, resulting in total monocular blindness, a complication that has been reported only once. To the best of our knowledge, it is the first time that a giant mucocele of such a large size is reported. We describe how the patient underwent surgical removal of this massive lesion, cranial base reconstruction, and a cosmetic oculoplastic procedure. The etiology, clinical presentation, and possible complications are reviewed, as well as the importance of a regular clinical follow-up and early surgical cure. Although the diagnosis and management of mucoceles are nowadays considered quite standard, the exceptional size of the lesion illustrated here emphasizes the destructive potential of such seemingly indolent lesions. Despite the benign histology of mucoceles, one should never underestimate their morbid potential or be lulled in delaying surgical cure. Large mucoceles should be removed as quickly as possible to prevent such unacceptable complications as permanent visual loss.

Néoplasie épithéliale de l'appendice: quoi de neuf [Epithelial neoplasia of the appendix: what has recently changed?].

Appendicular tumors are mostly found incidentally in up to 1.5% of all appendectomies. Neuroendocrine tumors are the commonest malignancies, and are associated with an excellent long-term prognosis. While small lesions located at the appendicular tip can be treated with simple appendectomy, advanced tumors require right hemicolectomy. Goblet cell carcinoids are rare tumors showing a mixed phenotype. Long-term outcome is impaired, and for most cases a right hemicolectomy is mandatory. Colonic-type adenocarcinomas have a similar behavior like conventional colonic cancer and should be treated similarly. Mucinous neoplasias possess the characteristic of extensive mucin production with intraperitoneal spread. Treatment options are ranging from right hemicolectomy to multivisceral resection with intraperitoneal chemotherapy.

Cirugía Bucal Ambulatoria en pacientes pediátricos. Casuística del año 2000 en la Clínica Odontológica de la Universidad de Barcelona

Objetivos: Este trabajo pretende demostrar que se pueden realizar la mayoría de las intervenciones quirúrgicas de la cavidad bucal en la población pediátrica en un medio ambulatorio, así como valorar y mostrar la actividad realizada en el Máster de Cirugía e Implantología Bucal de la Facultad de Odontología de la Universidad de Barcelona durante el año 2000. Diseño del estudio: Para la realización de este trabajo se ha contabilizado la actividad quirúrgica de las unidades de cirugía bucal y cirugía con láser en la población pediátrica en el Máster de Cirugía e Implantología Bucal de la Universidad de Barcelona. Resultados: De las 3187 intervenciones quirúrgicas realizadas en nuestro servicio, 489 fueron en pacientes menores de 18 años. La exodoncia quirúrgica de terceros molares inferiores fue la más frecuente (55'6%), seguida de otras extracciones dentarias (33'6%), quirúrgicas o no, y del resto de intervenciones (10'6%) que incluyeron: fenestraciones de caninos u otros dientes incluidos, exéresis de frenillos, de mucoceles y reubicaciones dentarias. Se presentaron complicaciones tras la extracción quirúrgica de los terceros molares en un 15'93% de los casos, siendo las más frecuentes el dolor (4'35%) y la tumefacción (4'35%), signos propios de la inflamación postoperatoria. Conclusiones: Nuestra experiencia muestra que la cirugía bucal ambulatoria puede practicarse de forma segura en la población pediátrica siempre y cuando se disponga de los medios y del personal sanitario adecuados

Typical and atypical presentations of paranasal sinus mucocele at computed tomography

Mucoceles are cystic masses that generally affect the sinuses. It occurs as a result from obstruction of the ostium of a sinus and consequential accumulation of mucus. Frontal and ethmoid sinuses are mostly affected. Usually, the clinical symptoms are insidious, varying with the extent of the affected region. The treatment is surgical and endoscopic surgery is the method of choice in most cases. The present study is aimed at describing the main characteristics of paranasal sinuses mucoceles, demonstrating and illustrating a series of atypical presentations with emphasis on imaging findings.

Tumor do apêndice vermiforme

Appendiceal tumors are rare and usually presented as acute appendicitis. They are incidentally discovered at an emergency surgery, in which case the decision-making is very difficult. The purpose of this report is discuss to the most appropriate management for appendiceal tumors. A retrospective analysis of one case treated at HU-UEL was undertaken and the literature was reviewed. The conclusion is that frozen section should be done whenever the appendiceal findings are atypical. For appendiceal carcinoids greater than 2 cm and adenocarcinomas, a right hemicolectomy is recommended. Appendectomy is apropriate for patients whose carcinoid tumors are 1 cm in diameter or less and for carcinoid tumors between 1 cm and 2 cm without extensive lymphatic permeation and mesenteric invasion. Every case should be searched for synchronous tumors.

Mucocele de apêndice

Appendiceal mucocele is a rare entity characterized by a gross enlargement of the appendix from accumulation of mucoid substance within the lumen. It is encountered in only 0.1 - 0.4% of all appendicectomies with a female predominance (M/F: 1/4) and a mean age of more than 50 years at the time of presentation . Because of that, appendiceal mucocele is often incidentally discovered either during surgery or on radiologic examination. A case of benign appendiceal mucocele is reported here, in a 49 years old male. The pathogenesis and the different surgical strategies are discussed.

Chimiohyperthermie intrapéritonéale à l’oxaliplatine dans le traitement de la carcinose péritonéale d’origine appendiculaire

Objectif : La carcinose péritonéale (CP) d’origine appendiculaire est une pathologie rare avec un pauvre pronostic à long terme. Le but de cette étude fut d’évaluer une approche agressive utilisée dans notre institution au cours des cinq dernières années. Méthodes : Les données de tous les patients avec CP d’origine appendiculaire ont été recueillies et analysées de façon prospective. Le traitement consista en une cytoréduction chirurgicale complète de la CP suivie d’une chimiohyperthermie intrapéritonéale (CHIP) à l’oxaliplatine (460 mg/m2) dans 2 L/m2 de D5% à 43°C pendant 30 minutes. Résultats : De février 2003 à mars 2007, 38 patients eurent une laparotomie à visée curative. Vingt-trois patients reçurent la CHIP. Par contre, chez 10 patients, une cytoréduction complète fut impossible et pour 5 autres patients, la chirurgie de « second-look » s’est révélée négative ; ils ne reçurent donc pas de CHIP. Le suivi moyen fut de 23 mois. La survie globale à 3 ans fut de 100% pour le groupe « second-look » négatif, 86% pour le groupe CHIP et 29% pour les patients avec maladie non-résécable (p=0.0098). La survie sans maladie (SSM) à 3 ans fut de 49% pour les patients du groupe CHIP. Le grade histologique fut identifié comme facteur pronostique en regard de la SSM dans le groupe CHIP (p=0.011). Il y eut un décès post-opératoire. Le taux de complications chez les patients traités fut de 39%, incluant les abcès intra-abdominaux (22%), les hémorragies (18%) et les fuites anastomotiques (9%). Conclusion : Bien que ces résultats soient préliminaires, cette approche thérapeutique semble à la fois faisable et sécuritaire chez des patients sélectionnés.

Approches thérapeutiques de la carcinose péritonéale d’origine appendiculaire récidivante

Objectif: Le traitement de la carcinose péritonéale (CP) d’origine appendiculaire récidivante demeure sous-étudié. L’objectif est d’évaluer le traitement à offrir aux patients présentant une récidive de la maladie. Méthodologie: Depuis 2003, les données de tous les patients avec CP d’origine appendiculaire traités dans notre centre ont été recueillies. Le traitement de la maladie primaire consistait en une cytoréduction chirurgicale complète de la CP suivie d’une chimiothérapie hyperthermique intra-péritoneale (CHIP) à l’oxaliplatine. Lors d’une récidive, une deuxième cytoréduction avec une CHIP à la mitomycine C était offerte aux patients rencontrant certains critères de sélection. Résultats: Un total de 58 patients ont subi une cytoréduction complète suivie d’une CHIP avec l’oxaliplatine. Durant la période de suivi, 22 patients démontrèrent une maladie récidivante (39%). Le péritoine était le site de récidive le plus fréquent. Les survies sans maladie étaient statistiquement différentes selon le grade histopathologique et le degré de complétude de la cytoréduction. Parmi ces 22 patients, huit patients ont reçu une deuxième cytoréduction suivie d’une CHIP à la mitomycine C, un patient a subi une cytoréduction complète seule et 13 patients avaient une maladie non résécable. La survie globale moyenne des patients ayant reçu un deuxième traitement fut de 28 mois. Les taux de morbidité et de mortalité suite à une deuxième cytoréduction suivie d’une CHIP furent de 25% et 0%, respectivement. Conclusion: Une cytoréduction suivie d’une CHIP demeure une intervention possible chez les patients qui présentent une maladie récidivante, mais certains critères doivent être appliqués afin de maximiser la survie et minimiser la morbidité et la mortalité de cette approche.

Apendicitis aguda perforada en adultos; aproximación a las inequidades sociales en salud, Bogotá 2012

La perforación del apéndice es una complicación temprana de la apendicitis aguda, demoras en el diagnóstico o tratamiento incrementan la tasa de perforación. Se desconoce si la perforación dl apéndice es un reflejo de inequidades sociales. Se pretendió determinar la asociación de la apendicitis aguda perforada en adultos y la equidad en acceso a salud. Estudio tipo cohorte retrospectivo documental, de historias clínicas de pacientes con apendicitis aguda; el análisis se realizó con Stata 11.1 y Epi-info. Los resultados se presentaron en tablas y figuras. Se incluyeron 540 casos (292 hombre y 248 mujeres), el grupo de edad que aporto más datos fue el de 18 a 49 años (391 pacientes); el tiempo medio de síntomas a consulta fue de 37,45 horas, y de 5,3 horas para el paso a cirugía desde el ingreso, fueron solicitadas 76 ecografías y 53 tomografías, 50 interconsultas a urología y 10 a ginecología hasta el diagnostico. El grupo de mayores de 49 años, el estrato socioeconómico tres y la tomografía fueron factores de riesgo independientes para perforación del apéndice. El análisis multivariado mostró asociación lineal entre el estrato socioeconómico y tiempo de síntomas al ingreso, tiempo para paso a cirugía, solicitud de ayudas diagnósticas e interconsultas, con buena significación estadística. La apendicitis aguda perforada en adultos, podría ser un indicador de inequidad en salud. Se requiere de estudios multi-céntricos, con mayor tiempo de evaluación y muestra para demostrar si el apéndice perforado es un trazador de inequidades en salud en Colombia.

Utilidad de la resonancia magnética en el diagnóstico de apendicitis aguda

Comparar el resultado de la resonancia magnética en el diagnóstico de apendicitis aguda con el patrón de oro (estudio histopatológico o seguimiento clínico del paciente) con el fin de establecer la utilidad de ésta como prueba diagnóstica y poder incluirla dentro del algoritmo de estudio de esta patología cuando hay sospecha clínica y un resultado negativo o dudoso de la ecografía abdominal

Mucus extravasation and retention phenomena: a 24-year study

Background: Mucoceles are benign lesions related to the minor salivary glands and their respective ducts frequently affecting oral structures which are generally asymptomatic. Mucoceles are generally characterized by swollen nodular lesions preferentially located on the lower lip and differ from the so-called ranulas, which are lesions located on the floor of the mouth and related to the sublingual or submandibular glands.Methods: The objective of the present study was to analyze data such as age, gender, race and site of the lesion of 173 mucocele cases diagnosed at the Discipline of Stomatology, Sao Jose dos Campos Dental School, UNESP, over a period of 24 years (April 1980 to February 2003).Results: of the 173 cases analyzed, 104 (60.12%) were females and 69 (39.88%) were males. Age ranged from 4 to 70 years (mean +/- SD: 17 +/- 9.53) and most patients were in the second decade of life (n = 86, 49.42%); white (n = 124, 71.68%). The lower lip was the site most frequently affected by the lesions (n = 135, 78.03%), whereas the lowest prevalence was observed for the soft palate, buccal mucosa, and lingual frenum.Conclusion: In this study, mucoceles predominated in white female subjects in the second decade of life, with the lower lip being the most frequently affected site.

Cistoadenoma mucinoso do apêndice: relato de caso

O cistoadenoma mucinoso do apêndice ceca l, um tipo de mucocele do apêndice, é uma neoplasia benigna caracterizada pela metaplasia focal ou difusa do epitélio superficial da mucosa, associada à dilatação do apêndice e produção de muco para a luz apendicular. No presente estudo os autores relatam um caso de cistoadenoma mucinoso do apêndice observado em uma mulher de 65 anos de idade, com dor e massa palpável no quadrante inferior direito do abdome, cujo quadro teve início há 1 ano. O diagnóstico de cistoadenoma do apêndice foi suspeitado através da ultrassonografia e tomografia computadorizada do abdome, e confirmado pelo exame histopatológico. A paciente também apresentava cálculos na vesícula biliar e um cisto renal à direita. A laparotomia foi indicada sendo realizada a apendicectomia, a colecistectomia e a exérese do cisto renal. Na presente discussão esperamos contribuir para o diagnóstico precoce dessa doença e a melhor compreensão de sua classificação e patogenia.

Mucocele of the glands of Blandin-Nuhn-clinical, pathological, and therapeutical aspects

Purpose: This study aims to review anatomical, clinical, and pathological concepts as well as to discuss the most adequate therapeutic approach to the mucoceles of the glands of Blandin-Nuhn. Discussion: The glands of Blandin-Nuhn are localized in the ventral part of the tongue, next to the apex in the lingual median plane. Development of a mucocele in this site is rarely seen; besides, as the glands of Blandin-Nuhn are not encapsulated and are directly overlapped to the muscle tissues, their manipulation tends to be different from the other oral mucoceles. Conclusion: As Blandin-Nuhn mucoceles are uncommon and their clinical appearance could be similar to other lesions, it is important that health professionals know their clinical and histopathological features to avoid having them misdiagnosed. © 2010 Springer-Verlag.