Linfangioma cístico do mesentério: uma rara apresentação de abdômen agudo

Mesenteric cyst is a rare intra abdominal pathology. The incidence ranges from 1/100,000 to 1/250,000 hospital admissions. The authors present a case of a female patient, 20 years old, with abdominal pain for four months which three days had an acute onset of abdominal pain, and ultrasound revealed a cyst of mesentery within a dense fluid. The patient had been submitted to a laparotomy, and resection of the cyst. We emphasized the clinical symptoms, diagnostic evaluation and the therapeutic of this condition.

Adenomioma da papila de vater em adulto jovem

The authors report a case of adenomyoma of papilla of Vater in a young adult, a rare pathology in this age and site. The commonest clinical findings are abdominal pain, dyspepsia and jaundice, as in this case in which the patient referred these symptoms for several months. The diagnosis is usually difficult before surgery, because the radiological and endoscopic appearances are difficult to interpret, since they may only show obstruction and enlargement of the biliary tract; in this way, the endoscopic biopsy may be useful. In the present case the computed tomography, abdominal scan and intraoperative cholangiography only demonstrated obstruction and enlargement of the biliary tract, without the presence of gallstones. The treatment is usually lesion resection according to its size, performing the total resection in those cases of extensive involvement of the digestive tract, as it was performed in this case, due to the dimension of the lesion and its malignant appearance. The patient was discharged from hospital on the thirteenth postoperative day, with a histological diagnosis of adenomyoma of papilla of Vater. Three months after the procedure the patient was asymptomatic.

Ressecção videolaparoscópica de hemangiopericitoma do estômago

In the present case (77 years-old woman), the diagnosis on an extramucosal lesion by endosonography was leiomyoma or schwanoma. Radiological exam of the upper digestive tract with barium and abdominal computed tomography confirmed the site of the lesion at the level of the lesser curvature. The operative technique followed the steps of the laparoscopic partial gastric resection (wedge resection) for gastric mesenchymal tumours, described elsewhere. The Endo-GIA stapler was introduced through the 12mm port in the right upper quadrant. Proper positioning of the stapler over the lesser curvature and a satisfactory margin of tissue around the mass were attained. Nine sequential firings of the Endo-GIA 30 were needed to completely surround the mass. Histopathological diagnosis was a spindle-cell tumour measuring 3cm in diameter. Mitotic index was measured at almost null. The neoplastic cells were strongly reactive for vimentine and CD34 and negative for the immunohistochemical markers S-100 protein, muscle actin, desmin and Ag linked to VIII factor. There was a slight reaction with keratin (+/+++). The XIIIA factor reaction revealed less than 5% of dendritic elements. These data favour a vascular cell origin better than smooth muscle cell origin. In conclusion it was a gastric hemangiopericytoma. Follow-up showed no recurrence at seven years.

Descoberta simultânea de carcinomatose disseminada e carcinoma de cólon, após colecistectomia laparoscópica

A particularly rapid and fatal outcome has been noted in cases of malignant soft-tissue metastases occurring after cancer surgery. Abdominal wall metastases occurring in scars after laparotomy for cancer resection show a similar poor outcome. On the other hand, neoplasm seeding at trocar sites after laparoscopy has been reported with an increasing frequency. A case is presented of a 68-years-old woman with metastatic seeding of non-diagnosed colon cancer at the umbilical trocar site used for a laparoscopic cholecystectomy. The gallbladder was extracted through the umbilical incision. Pathological examination confirmed chronic cholecystitis. Eight months latter, the patient was seen with a tender umbilical mass protruded through a 4,5 cm the umbilical incision site. Biopsies of this tissue were taken and histopathological examination showed metastatic adenocarcinoma, probably of a gastrointestinal origin. A colonoscopy performed at the same time revealed a 2-cm lesion at the hepatic flexur which was shown to be a differentiated adenocarcinoma. An 8.0 x 6.0 x 6.0-cm pelvic mass without signs of liver metastases was identified by computerised tomography. Diagnostic laparoscopy showed a diffuse peritoneal carcinomatosis. The pelvis could not be approached, except for simple biopsy, and no surgical procedure was performed. It is presumed that the primary colon cancer existed prior to cholecystectomy. Laparoscopy is the procedure of choice to perform cholecystectomy and fundoplication. It has also been increasingly used to diagnose, resect and perform the staging of malignant tumours. As in any relatively new technique, questions arising about its safety and risk of complications must be extensively studied. Many questions about the specific features of laparoscopy promoting cancer growth remain unanswered.

Linfangioma cístico do pâncreas

Lymphangiomas are benign neoplasias of lymphatic tissue, extremely rare in the pancreas. Three lymphangioma types exist: capillary, cavernous and cystic. The authors report a case of cystic lymphangioma of the pancreas, with incidental diagnosis to the abdominal ultrasonography on investigation of urinary symptoms in male patient. To the laparotomy upper cystic mass was identified in the pancreas, that was totally resected. The histological examination demonstrated a cystic lymphangioma of the pancreas. The cystic lymphangioma of the pancreas was discovered accidentally, being assintomatic in most of the cases. Treatment of choice is complete resection, otherwise recidive is higher than 50%.

Anastomose duodenoduodenal na pancreatoduodenectomia por pancreatite crônica

Literature has been showing a tendency of reducing the limits of Whipple's resection. The main technical advance was the pylorus preserving resection, technique proposed by Traverso and Longmire in 1978. The pancreticoduodenectomy for chronic pancreatitis, is probably the best opportunity to apply this type of procedure. In these specific patients, the author preserved the pylorus and the third portion of the duodenum. The gastrointestinal transit was reconstructed by the duodenumduodenal anastomosis and the bile duct and the pancreas were drained in a Roux-en-way loop . Follow-up showed no important complication, with no problems related to gastric emptying and without pain.

Leiomiossarcoma de jejuno

We describe a case of leiomyosarcoma of the jejunum in which abdominal computed tomography showed an intestinal tumor with a "sui generis" metalic artefact inside, which made us think of a benign disease (foreign body granuloma), because the patient lived in the rural area and he had a manioc flour mill, which is one the basic foods of the majority of the population of the north in Brazil. Because of the aspect of the tumor, we decided on a large scale resection, considering the possibility of a malignant tumor since we don't have frozen sections. This assured us of an adequate treatment for the tumor. This type of pathology should be remembered even though it only accounts for 0,2-2% of the intestinal tract tumors.

Tumor carcinóide do reto

The rectum is the second most common location of the carcinoid tumors of the gastrointestinal tract. It represents approximately one or two per cent of the rectal neoplasms. Metastases are less frequent and it presents a better prognosis than carcinoid tumors found in the digestive tract. Treatment is surgical and the technique to be used depends fundamentally on the size of the tumor and the degree of in the intestinal wall penetration. Lesions which are greater than one centimeter have been treated with local excision, while the ones greater than two centimeters have been submitted to a radical resection. This article presents a case of rectal carcinoid diagnosed and treated initially as adenocarcinoma by abdominal rectossigmoidectomy. There were no signs of recurrence after a period of five years and six months of post-surgical follow-up. Nowadays the validity of radical resection in the treatment of rectal carcinoids has been much questioned due to the fact that it has not shown a significant raise in survival rate when compared with patients who were submitted to a local resection.

Utilização da veia esplênica para restabelecer o fluxo sangüíneo mesentérico-porta após ressecção de veia mesentérica superior durante duodenopancreatectomia

Superior mesenteric vein invasion has historically been considered a contraindication for pancreatic cancer resection. Several studies have shown that in selected cases vascular resection can be performed safely. Many techniques have been used to reconstruct the venous flow. We describe one case of mesenteric superior vein resection and reconstrution of mesenteric-portal venous flow using the splenic vein during a pancreatoduodenectomy for pancreatic adenocarcinoma. The patient presented an extensive involvement of the superior mesenteric vein. A segmental resection with an end-to-end anastomosis of this vein and the splenic vein was accomplished after splenectomy. The patient had histologically confirmed negative margins. There was no hospital complications. These results show that the splenic vein can be an option for venous flow reconstruction when a segmental vascular resection is required during at pancreaticoduodenectomy.

Neoplasia papilar cística do pâncreas

Papyllary cystic tumor of the pancreas, so-called Frantz's tumor, is rare. Clinical presentation of this disease is usually a slowly growing abdominal mass with or without abdominal pain, affecting predominantly young females. Its pathogenesis is still unknown . Surgical resection is usually curative, and prognosis is excellent. The authors report two pancreatic tumor cases(Frantz's tumor) in women aged 26 and 31 years old. Pre operative assessment showed a solid-cystic tumor of the tail and body of the pancreas. An extended distal pancreatectomy was performed without splenic preservation.

Localização de insulinoma pela injeção seletiva intra-arterial de cálcio

Insulinomas are rare endocrine tumors with an estimated incidence of 1(one) per million. Optimal therapy for all islet tumors of the pancreas is curative surgical resection. However, previous reports have show that, in the absence of preoparative localization, insulinoma may not be found intraoperatively in about 20% of patients. With current imaging technology, including serial computed tomography (CT), magnetic resonance imaging (MRI) and ultrasonography, localization of insulinomas less than 2cm remains inadequate. This case report shows that selective intraarterial calcium injection with hepatic venous sampling for insulin levels measured is a efficient technique for the localization of insulinomas.

Adenocarcinoma de apêndice: relato de dois casos

The authors report two cases of patients with appendix adenocarcinoma, manifested as a syndrome of abdominal tumor of unknown origin. It was not possible to perform etiological diagnosis in the preoperative period for any of them. Literature data show that large locoregional tumor is a manifestation of appendix adenocarcinoma, although acute appendicites is the most frequent clinical manifestation. Preoperative diagnosis is rare and usually performed during laparotomy or through histopathological examination of the specimen. In large tumors, total mass resection including hemicolectomy should be carried out whenever possible. Whenever diagnosis of appendix adenocarcinoma is performed by the histopathological examination of the acute appendicites specimen, re-intervention is indicated for a right hemicolectomy.

Pseudotumor inflamatório do pulmão

We report a case of a ten year old boy with an inflammatory pseudotumor in the right upper lobe. Surgical excision was undertaken. Inflammatory pseudotumors of the lung often occur in children. We recommend complete resection for diagnosis and cure. This tumor can mimic malignant neoplastic lesions and can recur after surgical treatment.

Cisto de mesentério

Mesenteric cyst is a rare abdominal disease, with a higher incidence among women and 1: 250.000 incidence among hospitalized adults and 1: 200.000 among hospitalized children. Thereby, we report a case of a 10 years old child, male, presenting a large mesenteric cyst, which occupied almost all the abdominal and pelvic cavities and treated by resection during laparotomy.

Adenocarcinoma primário de duodeno

Primary adenocarcinoma of the duodenum is an extremely rare disease, and represents only 0.35% of all gastrointestinal malignancies. Early detection of the disease may be difficult because of the absence of pathognomonic symptoms. The authors relate one case of a adenocarcinoma of the duodenum in a 61-year-old white man with a history of abdominal pain for a six-month period, associated with postprandial fullness, vomiting and weight loss. Contrasted x-ray and computerized tomography showed a tumor in the fourth segment of the duodenum, with partial obstruction of the lumen. Histological study revealed a moderate differentiated adenocarcinoma. Treatment consisted of resection of the fourth portion of duodenum. The authors comment on the most important aspects of this pathology.