Search

The most frequent presentation of esophageal cancer is adenocarcinoma and squamous cell carcinoma. In recent years, the latter has decreased its incidence increasing the adenocarcinoma. Currently, another type of tumor with a much lower incidence has been described, which has a neuroendocrine component along with another exocrine glandular component and has been classified since 2010 as mixed adenoneuroendocrine carcinoma (MANEC). We present the case of a 68‑year‑old male with a history of dyspepsia and epigastric pain who after performing a gastroscopy, was diagnosed with a malignant neoplasm of the esophagus. The patient underwent a total esophagectomy with reconstruction by tubular gastroplasty with cervical anastomosis. The final result of the piece after immunohistochemistry revealed that the tumor was composed of one component of adenocarcinoma in 60% together with another component compatible with neuroendocrine in 40%. With these findings and according to the World Health Organization classification of 2010 was diagnosed as esophageal MANEC. MANECs are rare tumors, described in other locations of the digestive tract, the esophagus being an infrequent location. Its preoperative diagnosis is difficult, and it is not until the final analysis of the complete piece by means of specific immunohistochemical techniques when its diagnosis can be established. Its treatment is fundamentally surgical, whereas the adjuvant therapeutic schemes with chemotherapy are not well defined at present because of their low incidence.Keywords: Adenocarcinoma mixed tumor, collision tumor, esophagus, gastroesophageal junction, mixed adenoneuroendocrine carcinoma

Introduction: Cystic adrenals are uncommon lesions that must be distinguished from other retroperitoneal or adrenal tumours. They are a heterogeneous group and vascular adrenal cysts constitute the most common type. The vast majority of these tumours are silent; however, occasionally, they can present a great variety of symptoms such as mass effect, abdominal pain or discomfort. They are benign lesions without malignant potential that can require surgical treatment to confirm diagnosis or alleviate symptoms. The development of imaging techniques has increased the number of lesions diagnosed incidentally. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are useful tools to evaluate these lesions as well as their relation with surrounding structures. Material and methods: We report a vascular adrenal cyst occurring in a 75 year old man that presented abdominal pain and mass on the left side of the abdomen. Imaging techniques showed a retroperitoneal tumour with a size of 22 × 25 × 22 cm that displaced surrounding structures although without signs of invasion. Due to the symptoms and the size of the lesion, the patient underwent surgery. The postoperative period was uneventful and histological study revealed a vascular adrenal cyst. Conclusion: Vascular adrenal cysts constitute a rare entity. Surgery is mandatory for large lesions, symptomatic patients and to confirm diagnosis.

Objetivo: El objetivo de este estudio es comunicar los resultados observados en una serie de pacientes con diagnóstico de gangrena de Foumier sometidos a aseo quirúrgico con debridamiento más terapia antibiótica de amplio espectro, en el Servicio de Urgencias del Hospital Barros Luco-Trudeau (HBLT), entre los años 2009 y 2013, en términos de mortalidad asociada a la enfermedad. Material y Método: Serie de casos de pacientes con diagnóstico de gangrena de Foumier tratados en el Servicio de Urgencias del Hospital Barros Luco-Trudeau entre 2009 y 2013. La variable resultado fue mortalidad atribuida a la enfermedad (MAE). Otras variables de interés fueron: edad, sexo, patologías asociadas, foco de origen, tiempo de espera para el inicio del tratamiento antibiótico y cirugía, número de aseos y agentes aislados en los cultivos. Se utilizó estadística descriptiva, con cálculo de medidas de tendencia central y dispersión. Resultados: En el período en estudio se identificaron 56 pacientes con diagnóstico de Gangrena de Fournier (60,7% eran masculinos), con un promedio de edad de 52 años (23-75 años). La MAE fue 48,2%. La patología asociada más frecuente fue la diabetes (66,6%). El foco de origen más prevalente fue la patología anorrectal (42,9%). El tiempo promedio de espera desde el diagnóstico hasta el inicio de la terapia antibiótica y la cirugía fue de 40 minutos (15-80) y 580 minutos (20-4320) respectivamente. El promedio de aseos requeridos fue de 4. El agente más aislado en los cultivos de tejido intraoperatorio fue Escherichia coli (51,8%). Conclusión: La mortalidad atribuible a la Gangrena de Fournier es similar a la observada en la literatura.

Objetivo: El objetivo de este estudio es comunicar los resultados observados en una serie de pacientes con diagnóstico de gangrena de Foumier sometidos a aseo quirúrgico con debridamiento más terapia antibiótica de amplio espectro, en el Servicio de Urgencias del Hospital Barros Luco-Trudeau (HBLT), entre los años 2009 y 2013, en términos de mortalidad asociada a la enfermedad. Material y Método: Serie de casos de pacientes con diagnóstico de gangrena de Foumier tratados en el Servicio de Urgencias del Hospital Barros Luco-Trudeau entre 2009 y 2013. La variable resultado fue mortalidad atribuida a la enfermedad (MAE). Otras variables de interés fueron: edad, sexo, patologías asociadas, foco de origen, tiempo de espera para el inicio del tratamiento antibiótico y cirugía, número de aseos y agentes aislados en los cultivos. Se utilizó estadística descriptiva, con cálculo de medidas de tendencia central y dispersión. Resultados: En el período en estudio se identificaron 56 pacientes con diagnóstico de Gangrena de Fournier (60,7% eran masculinos), con un promedio de edad de 52 años (23-75 años). La MAE fue 48,2%. La patología asociada más frecuente fue la diabetes (66,6%). El foco de origen más prevalente fue la patología anorrectal (42,9%). El tiempo promedio de espera desde el diagnóstico hasta el inicio de la terapia antibiótica y la cirugía fue de 40 minutos (15-80) y 580 minutos (20-4320) respectivamente. El promedio de aseos requeridos fue de 4. El agente más aislado en los cultivos de tejido intraoperatorio fue Escherichia coli (51,8%). Conclusión: La mortalidad atribuible a la Gangrena de Fournier es similar a la observada en la literatura. Aim: The aim of this study is to report the results of a series of patients diagnosed with Fournier’s gangrene underwent surgical debridement plus broad-spectrum antibiotics in the emergency department of the Hospital Barros Luco-Trudeau (HBLT) between 2009 and 2013, in terms of mortality associated with the disease. Material and Methods: Between 2009 and 2013, a case series of patients with diagnosis of Fournier’s gangrene treated in the Emergency Department of the Hospital Barros Luco-Trudeau. The outcome variable was mortality attributed to the disease (MAD). Other variables were: age, sex, comorbidities, focus of origin, waiting time for antibiotic treatment and surgery to start, number of surgical debridement and agents isolated from cultures. Descriptive statistics were used, with calculation of measures of central tendency and dispersion. Results: During the study period, 56 patients were identified with diagnosis of Fournier’s gangrene (60.7% were male) with a mean age of 52 years (23-75 years old). The MAD was 48.2%. The most common comorbidity was diabetes (66.6%). The more prevalent focus of origin was anorectal pathology (42.9%). The average waiting time from diagnosis to initiation of antibiotic therapy and surgery was 40 minutes (15-80) and 580 minutes (20-4320), respectively. The required surgical debridement average was 4. Isolated on the intraoperative tissue cultures agent was E. coli (51.8%). Conclusion: Mortality attributable to Fournier’s gangrene is similar to that observed in the literature.

Introduction In vitro activation and growth of primordial dormant follicles to produce fertilizable oocytes would provide a useful instrument for fertility preservation. The employment of Phosphatase and TENsin homolog (PTEN) inhibitors, in combination with Protein kinase B (Akt) stimulating molecules, has been previously employed to increase follicular activation through the stimulation of the PTEN-Akt pathway. Methods We aim to establish improved in vitro activation also for cancer patients whose ovarian tissue has already been cryopreserved. Fresh and previously cryopreserved human ovarian cortex were exposed to short-term, low-concentration and ovary-specific treatment with only a PTEN inhibitor. Results Our in vitro activation protocol enhances the activation mechanisms of primordial follicles in both fresh and cryopreserved samples, and enlarges growing populations without inducing apoptosis in either follicles or the surrounding stroma. Treatment augments estradiol secretion wand restores the expression levels of the previously diminished Anti-Mullerian hormone by means of cryopreservation procedures. Genomic modulation of the relative expression of PTEN pathway genes was found in treated samples. Conclusion The in vitro activation protocol offers new alternatives for patients with cryopreserved tissue as it increases the pool of viable activated follicles available for in vitro growth procedures. The combination of ovarian tissue cryopreservation and in vitro activation of primordial follicles, the main ovarian reserve component, will be a major advancement in fertility preservation.

Objective: To develop a novel molecular panel of markers to detect breast cancer (BC) disseminated malignant cells in ovarian tissue, and to improve the safety of ovarian tissue transplantation. Design: Experimental study. Setting: University hospital. Patient(s): Ten ovarian biopsies from healthy patients, 13 biopsies with diagnosed BC metastasis, and 4 biopsies from primary BC tumor for designing a diagnostic panel of BC cell contamination; 60 ovarian biopsies from BC patients undergoing fertility preservation for validating the panel. Animal(s): Female nude mice. Intervention(s): A novel panel for BC malignant cell detection by reverse-transcription polymerase chain reaction (RT-PCR), inmmunohistochemical analysis, in vitro invasion assay and xenotransplantation assayed in ovarian tissue from BC patients. Main Outcome Measure(s): Expression of GCDFP15, MGB1, SBEM, MUC1, WT-1, and NY-BR-01, selected as markers, assessed by quantitative RT-PCR in samples with confirmed BC metastasis. The most sensitive markers were confirmed by immunohistochemistry, and tested in vitro and in vivo. Result(s): GCDFP15, MGB1, and SBEM were the most sensitive and specific markers to detect BC metastatic cells when at least one was expressed by quantitative RT-PCR. The panel was validated in 60 patients and confirmed in an in vitro invasion assay, where no invasive cells were observed. Samples negative for BC cells cannot develop disease when xenografted. Conclusion(s): GCDFP15, MGB1, and SBEM were the most sensitive molecules to create a diagnostic panel for BC malignant cell contamination, which may make ovarian tissue cryopreservation and transplantation a safe technique for fertility preservation in BC patients. (C) 2015 by American Society for Reproductive Medicine.