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Resumen El linfoma de celulas B extranodal de la zona marginal del tejido asociado a mucosas es de bajo grado de malignidad y representa el 0,04-0,53% de todos los tumores malignos de la mama y el 2,2% de los linfomas malignos extranodales. Se asocia a enfermedades autoinmunes. En la mama se presenta habitualmente como un tumor unico, indoloro y de rapido crecimiento. En algunos casos existe compromiso de la piel y adenopatias axilares. Presentamos el caso de una mujer de 39 anos con artritis reumatoide de 20 anos de evolucion, que presenta desde hace 5 meses una tumoracion palpable en la mama izquierda de 4 cm y lesiones eritematosas cambiantes en la piel de ambas mamas. Los hallazgos radiologicos fueron similares a los del resto de las tumoraciones malignas, por lo que para su diagnostico fue necesario un estudio anatomopatologico, inmunohistoquimico y molecular.

To analyse the effects of training in elective colorectal laparoscopic surgery with a minimum 6 months follow up to assess early and delayed complications, and comparing the first 40 cases in the 1st Period (P-1: 1996-2002) with the 100 cases in the 2nd Period (P-2: 2003-2008). One of the surgeons had two training courses between P-1 and P-2.A total of 66 colorectal resections due to cancer were performed and 74 operations for benign disease. The cases of malignant diseases increased between P-1 and P-2 (P0.001). (Odds-Ratio=0.16).There number of complex cases increased between P-1 and P-2 (Anterior resection-amputation, left hemicolectomy, total colectomy, rectopexy) vs. Others (Sigmoidectomy, right resections) (P0.05), but the mean duration of the operations was reduced by 29 minutes P0.01). There were 24% conversions, with no change in P-2 (P=0.85). Surgical mortality at 3 months (1.4%) showed no differences (P=0.49). The total complications rate (31%) was significantly lower in P-2 (P=0.001), because medical complications (P=0.05), the more serious surgical complications (with reintervention) (P=0.05) and wound infections (P=0.0001) were lower. There was no change in the other surgical complications (P=0.61). The overall mean stay was 7.8 days (3-36) (median=6 days), with no differences between P-1 and P-2 (P=0.165). Conversion significantly lengthened the mean hospital stay (P=0.015) (from 7.2+/-5 days to 10.1+/-7 days), but there was no increase in complications (P=0.31).Training in colorectal laparoscopy and training periods with experts improve results (duration, complications, more complex surgery). Conversions did not decrease with experience and the hospital stays lengthened, but they were not associated with more complications.

Resumen Objetivo Analizar el efecto del aprendizaje en cirugia electiva laparoscopica colorrectal con seguimiento minimo de 6 meses para contabilizar complicaciones precoces y tardias mediante la comparacion de los primeros 40 casos del primer periodo (P1) (1996 a 2002) con los 100 casos del segundo periodo (P2) (2003 a 2008). Entre P1 y P2, uno de los cirujanos realizo 2 estancias formativas. Material y metodos Se realizaron 66 resecciones colorrectales por cancer y 74 intervenciones por enfermedad benigna. Entre P1 y P2 se incrementaron los casos de enfermedad maligna (p odds ratio =0,16). Resultados Entre P1 y P2 se incrementaron los casos de intervenciones complejas (reseccion anterior-amputacion, hemicolectomia izquierda, colectomia total, rectopexia) frente a otras (sigmoidectomia, resecciones derechas) (p La estancia media global fue de 7,8 dias (3 a 36) (mediana de 6 dias), sin diferencias entre P1 y P2 (p=0,165). La conversion alargo significativamente la estancia media (p=0,015) (de 7,2±5 dias a 10,1±7 dias), pero no incremento las complicaciones (p=0,31). Conclusion El adiestramiento en laparoscopia colorrectal y las estancias de formacion con expertos mejoran los resultados (duracion, complicaciones, cirugia mas compleja). Con la experiencia, las conversiones no disminuyen y alargan la estancia hospitalaria, pero no se asocian a mas complicaciones.

Circumferential resection margin (CRM) involvement in patients undergoing surgery for rectal tumors is a factor predicting poor prognosis in terms of the possibility of local recurrence, distant recurrence, and survival. CRM involvement has been related to the quality of the surgery. We analyzed the rate of CRM involvement in patients with locally-advanced rectal cancer undergoing neoadjuvant therapy and its relation with disease-free survival (DFS) and disease-specific survival (DSS).A total of 101 patients diagnosed with rectal adenocarcinoma between January 2001 and December 2001 who underwent surgery after receiving neoadjuvant radiochemotherapy were included. The CRM was considered positive when the distance between the tumor and the surgical border was less than 1 mm. The relation between CRM involvement and DFS and DSS was evaluated using the log-rank test.The mean age was 66.6 years. The rate of CRM involvement was 10.8% (11 patients); CRM involvement was due to proximity or contact of the CRM with the tumor in 7 patients, proximity of enlarged nodes in 2 patients, perineural invasion in the CRM in 1 patient and discontinuous tumoral growth in 1 patient. With a mean follow-up of 25.4 months, disease recurrence was diagnosed in 13 patients: local recurrence occurred in 3 (2.97%) patients and distant metastases in 10 (9.9%). Eleven (10.8%) patients died from disease progression. CRM involvement was significantly related to DFS (p = 0.0167) and DSS (p = 0.0176).In patients undergoing surgery for rectal cancer after neoadjuvant radiochemotherapy, CRM involvement is a negative prognostic factor for DFS and DSS.