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Although morphology is the key to histological diagnosis, gastric mesenchymal tumors can share very similar growth and cellularity patterns, sometimes being indistinguishable. Therefore, immunohistochemical techniques are going to be crucial in the definitive diagnosis. The objective of this work is to perform an immunohistochemical differential diagnosis of gastric mesenchymal tumors.

Papillary thyroid microcarcinoma (PTMC) usually has an indolent course, but some have worse prognostic factors, such as the presence of central (6.9%-51.5%) and lateral (3%-49.6%) lymph node metastases. The aim of this study is to analyze the factors associated with PTMC with metastatic lymph nodes and its long-term prognosis.Retrospective study whose study population consists of patients with PTMC (size ≤1cm). Patients with previous thyroid surgery, other synchronous malignancies and ectopic location of the PTMC were excluded. Two groups were compared: PTMC without metastatic lymph nodes (group 1) and PTMC with metastatic lymph nodes (group 2). A multivariate analysis using a logistic regression model and a Kaplan-Meier survival analysis with log-rank test were performed.Out of the 161 selected patients, 9.3% (n=15) had metastatic lymph nodes. Multifocality (OR 5.284, 95%CI 1.056-26.443; P=.043) and extrathyroidal extension (OR 7.687, 95%CI 1.405-42.050; P=.019) were associated with the presence of metastatic lymph nodes. In PTMC with metastatic lymph nodes, more aggressive treatments were performed: lymphadenectomy (4.8% vs. 100%; P.001) and radioactive iodine (24.7% vs. 100%; P.001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 6.7%; P=.093). No patients died due to the disease.Multifocality and extrathyroidal extension of PTMC were associated with the presence of metastatic lymph nodes. Metastatic PTMC, with more aggressive treatments, presents an excellent long-term prognosis.

Resumen Introduccion El microcarcinoma papilar de tiroides (MCPT) suele tener un curso indolente, pero algunos presentan factores de peor pronostico, como la presencia de adenopatias metastasicas centrales (6,9-51,5%) y laterales (3-49,6%). El objetivo de este estudio es analizar los factores asociados al MCPT con adenopatias metastasicas y su pronostico a largo plazo. Metodos Estudio retrospectivo cuya poblacion a estudio la constituyen los pacientes con MCPT (tamano ≤ 1 cm). Se excluyen los pacientes con cirugia tiroidea previa, otras patologias malignas sincronicas, y localizacion ectopica del MCPT. Se comparan dos grupos: MCPT sin adenopatias metastasicas (grupo 1) y MCPT con adenopatias metastasicas (grupo 2). Se realizan un analisis multivariante mediante una regresion logistica y un analisis de la supervivencia mediante el metodo de Kaplan-Meier y el test log-rank. Resultados De los 161 pacientes seleccionados, el 9,3% (n = 15) tuvo adenopatias metastasicas. La multifocalidad (OR 5,284, IC 95% 1,056-26,443; p = 0,043) y la invasion extracapsular (OR 7,687, IC 95% 1,405-42,050; p = 0,019) se asociaron con la presencia de adenopatias metastasicas. En el MCPT con adenopatias metastasicas, se realizaron tratamientos mas agresivos: linfadenectomia cervical (4,8% vs. 100%; p Conclusiones La multifocalidad y la invasion extracapsular del MCPT se asocian con la presencia de adenopatias metastasicas. El MCPT metastasico, con tratamientos mas agresivos, presenta un excelente pronostico a largo plazo.

We report the case of a 65-year-old male with hypertension, diabetes and hypercholesterolemia, who presented due to pyrosis and regurgitation. A CT scan incidentally identified esophageal compression at two sites because of vascular abnormalities, which was asymptomatic. The proximal compression was due to a Kommerell's diverticulum (Fig. 1) and the distal one due to aortic tortuosity (Fig. 2). Esophageal manometry revealed a distal obstructive pattern of mechanical origin, which was consistent with the observed aortic kink. The esophagogram (Fig. 3) showed a proximal filling defect and a bend in the distal third.

Pulmonary Tuberculosis (TB) has increased in Spain in recent years due to multiple factors. Peritoneal tuberculosis represents the sixth cause of extrapulmonary tuberculosis, accounting for 11% of tuberculosis cases. We report a 28-year-old male from Mali, who arrived at our hospital with an acute abdomen due to intestinal perforation with a computed tomography scan (CT) performed peritoneal tuberculosis mimicking primary carcinomatosis. This presents a diagnostic and therapeutic challenge, since the surgical approach differs in both cases, and the prognosis is very different between them.

We have read with interest the article by Pérez Montiel CA et al., in which goblet cell adenocarcinoma (GCA) is described as a cause of acute appendicitis. Although the article is brilliant in terms of histopathological description of the appendiceal GCA, the surgical indication for right hemicolectomy should be analyzed in depth due to the great controversy that exists in the scientific literature.

Streptococcus constellatus is a Gram-positive commensal bacterium of the oropharyngeal, gastrointestinal and urogenital flora. It can cause abscesses in different parts of the body, especially in immunocompromised patients. We present the clinical case of a 33-year-old female patient with a previous history of one anastomosis gastric bypass, among others. The patient was hospitalized two years after surgery for peritonitis secondary to a perforation in the biliopancreatic loop, underwent laparoscopic surgery and was hospitalised for two weeks. Fifteen days after being discharged from the hospital, she went to the emergency service for abdominal pain and fever. An abdominal and pelvic computerized tomography (CT) scan showed a multiloculated pelvic collection with thickened and hypercapillary walls.

We read with interest the article by Garrido Durán C, et al. in which endoscopic aspects of duodenal levodopa/carbidopa therapy in the treatment of advanced Parkinson's disease were analyzed. In this article, buried bumper syndrome (BBS) is documented in 5.4 % of cases. Normally, the initial treatment of BBS is endoscopic therapy, although sometimes surgery may be necessary. Thus, 4 cases of BBS treated with surgery are presented.

The incidence of papillary thyroid microcarcinoma (PTMC) is increasing.To analyze the long-term prognosis of PTMC.Study population: patients with a histopathological diagnosis of PTMC (size ≤ 1 cm) treated according to the risk of recurrence of the Latin American Thyroid Society. Inclusion criteria: minimum follow-up of 2 years, availability of histopathological samples, and treatment compliance. Exclusion criteria: previous thyroid surgery, other synchronous malignancies or ectopic location of the PTMC. Study variables: persistences, recurrences and mortality.Based on the risk of recurrence, PTMC has very low risk in 65.2% (n = 105), low risk in 17.4% (n = 28) and high risk in 17.4% (n = 28). In high risk patients, total thyroidectomy was performed in all cases, cervical lymphadenectomy in 57,1% (n = 16) and metabolic therapy with IPTMC treated based on its risk of recurrence has a good long-term prognosis, without persistences, with a low number of recurrences and absence of disease-associated mortality.La incidencia del microcarcinoma papilar de tiroides (MCPT) está aumentado.Analizar el pronóstico a largo plazo del MCPT.Población a estudio: pacientes con diagnóstico histopatológico de MCPT (tamaño ≤ 1 cm) tratados según el riesgo de recurrencia de la Sociedad Latinoamericana de Tiroides. Criterios de inclusión: seguimiento mínimo de 2 años, disponibilidad de las muestras histopatológicas y cumplimiento del tratamiento. Criterios de exclusión: cirugía tiroidea previa, otras patologías malignas sincrónicas o localización ectópica del MCPT. Variables a estudio: persistencias, recidivas y mortalidad.Según el riesgo de recurrencia, el 65.2% (n = 105) tuvo muy bajo riesgo, el 17.4% (n = 28) bajo riesgo y el 17,4% (n = 28) alto riesgo. En los pacientes de alto riesgo se realizó tiroidectomía total en todos los casos, linfadenectomía cervical en el 57,1% (n = 16) y terapia metabólica con IEl MCPT tratado en función del riesgo de recurrencia tiene un buen pronóstico a largo plazo, sin persistencias, con una baja cifra de recurrencias y ausencia de mortalidad debida a la enfermedad.

Background The incidence of papillary thyroid microcarcinoma (PTMC) is increasing. Objective To analyze the long-term prognosis of PTMC. Method Study population: patients with a histopathological diagnosis of PTMC (size ≤ 1 cm) treated according to the risk of recurrence of the Latin American Thyroid Society. Inclusion criteria: minimum follow-up of 2 years, availability of histopathological samples, and treatment compliance. Exclusion criteria: previous thyroid surgery, other synchronous malignancies or ectopic location of the PTMC. Study variables: persistences, recurrences and mortality. Results Based on the risk of recurrence, PTMC has very low risk in 65.2% (n = 105), low risk in 17.4% (n = 28) and high risk in 17.4% (n = 28). In high risk patients, total thyroidectomy was performed in all cases, cervical lymphadenectomy in 57,1% (n = 16) and metabolic therapy with I131 in all cases. During a mean follow-up of 119,8 ± 65 months, 0.6% (n = 1) of recurrences took place. Risk factors associated to recurrence were not identified. No patient died due to MCPT. Conclusions PTMC treated based on its risk of recurrence has a good long-term prognosis, without persistences, with a low number of recurrences and absence of disease-associated mortality.

Melanoma metastasizes to the gastrointestinal tract in 2-4% of cases. In addition, it is the tumor that most frequently metastasizes to the gallbladder (50-67% of metastasis at this level). Even so, these metastases are infrequent. The indication of cholecystectomy will be provided by the patient performance status, extension and prognosis of disease. Although open surgery is preferred to treat melanoma metastasis at this level, laparoscopic surgery could be a safe technique that allows a fast recovery of the patient. We present the case of a 48-year-old man with melanoma metastases in the gallbladder treated by laparoscopic cholecystectomy.

Chilaiditi's sign is the interposition of small bowel or colon between the liver and diaphragm. This incidental finding is seen in 0,025-0,28% of the chest and abdominal radiographies. Predisposing factors include the absence, laxity or elongation of the suspensory ligaments of the transverse colon, redundant colon or elevation of the right hemidiaphragm. Atrophy or hypoplasia of the liver is an uncommon cause of this radiological sign. On the other hand, suprahepatic gallbladder is the most infrequent location of gallbladder ectopies (0,026-0,7%). It is associated with an abnormal development of the right liver lobe such as agenesis, hypoplasia or atrophy. We present the case of a 73-year-old man with Chilaiditi's sign, hepatic hypoplasia and acute calculous cholecystitis in an ectopic suprahepatic gallbladder.

Purpose The higher sensitivity of new diagnostic tools makes it easier to detect relapse in asymptomatic stages when classic procedures of lymph node biopsies are difficult to perform. The aim of this article is to describe the combination of gamma probe and 18F-FDG positron emission tomography-computed tomography (PET-CT) images in combination with sentinel lymph node biopsy technique for detection of nonpalpable lymph nodes. Methods After a dose of 18F-FDG was administered and PET-CT images that showed the location of suspected pathologic lymph nodes were obtained, transcutaneous localization of the lymph nodes with the highest captation of the tracer was done. The gamma probe was programmed to detect the radioactive signal from the F18, instead of the Tc99m that is usual in the sentinel node biopsy technique. Once the hottest point was detected, a short incision was made on this area, and suspicious nodes with the highest uptake registered by the gamma probe were localized and removed. After the surgical removal from the operating field, the surgical pieces stood positive to the gamma probe. Lymph node involvement, and subsequent relapse, was diagnosed before their clinical manifestation. Conclusions This methodology confirms new horizons for the surgical approach of lymph node biopsies in patients with previous tumors with 18F-FDG avidity and suspicion of relapse.

Resumen Introduccion Las urgencias por enfermedad mamaria son procesos infrecuentes, siendo las mastitis y los abscesos los mas habituales. Los hematomas mamarios, a pesar de su baja frecuencia, pueden requerir un manejo terapeutico urgente. Caso clinico Presentamos el caso de una mujer de 74 anos, anticoagulada con acenocumarol debido a una fibrilacion auricular cronica, que acudio a urgencias por una tumoracion de crecimiento progresivo a nivel de la mama derecha tras una extension del miembro superior derecho. En la exploracion fisica se aprecio inestabilidad hemodinamica de la paciente y un gran hematoma en mama derecha que se extendia a la pared toracica lateral. Estabilizada la paciente y corregida la coagulacion se intento la embolizacion radiologica del vaso sangrante, siendo esta infructuosa, por lo que finalmente se realizo un drenaje quirurgico drenando un gran hematoma. Conclusion Los hematomas mamarios grandes que provocan inestabilidad hemodinamica deben ser drenados quirurgicamente, sin intentar medidas conservadoras previamente.

The indication for liver transplantation in patients with history of lymphoma is little-known, and the references documented in the medical literature are still limited. We present the case of a 63-year-old man who was diagnosed with chronic hepatopathy due to HBV 15 years ago. He was operated on for hepatocellular carcinoma in the segment VI of the liver 4 years ago, finding a macronodular liver cirrhosis during the surgery. Fifteen months later, the patient was diagnosed with diffuse large B-cell gastric lymphoma (fig.1). After a good response to chemotherapy treatment with R-CHOP scheme, the patient has been in complete remission for 36 months. Currently, the patient has a Child-Pugh score of 5 points, MELD score of 6 points, an undetectable viral load and it does not exist any evidence of hepatocellular carcinoma recurrence. With respect to this case, could it be considered liver transplantation in any assumption or would it be rejected in any case due to the recent history of lymphoma? In this case report, it has decided to do a periodic follow-up of the patient, but because of the good prognosis of the lymphoma, liver transplantation may be performed in the case of hepatocellular recurrence, worsening of liver function (Child-Pugh B or C) or fulminant hepatic failure due to HBV reactivation. There is not yet consensus about the interval between lymphoma remission and liver transplantation, therefore it recommends an individual oncologic evaluation in order to establish the recurrence risk before deciding on the indication for liver transplantation.

El signo del «3 invertido» de Frostberg o signo de epsilon aparece en el transito gastroduodenal porque la cabeza pancreatica tracciona sobre la segunda porcion duodenal, desapareciendo la forma de la letra C y apareciendo la de epsilon (e). Tiene lugar en el 3% de los tumores periampulares y no es diagnostico, ya que tambien puede presentarse en pancreatitis o u lceras postbulbares. Presentamos el caso de un varon de 70 anos con pancreatitis cronica, que consulto por intolerancia digestiva. El transito gastroduodenal (fig. 1) evidencio dicho signo. Tras varias pruebas diagnosticas, se descarto malignidad mediante puncion guiada por ecoendoscopia.

We analyzed the role of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) on the microscopic component of the disease in patients with a first recurrence of platinum-sensitive ovarian cancer after complete cytoreduction (CCR). We analyzed the data of 54 patients who were operated on between January 2001 and July 2012 with the diagnosis of platinum-sensitive recurrent ovarian cancer. In all patients, it was possible to achieve a CCR. Patients were divided into two groups: group I (cytoreduction alone) consisted of 22 surgical patients and group II (cytoreduction and HIPEC) consisted of 32 patients. There were no significant differences in any of the preoperative variables studied. After a multivariate analysis of factors identified in the univariate analysis, only the presence of tumors with undifferentiated histology (hazard ratio 2.57; 95 % CI 1.21–5.46; p

Varon de 75 anos, inmunocompetente, diagnosticado de esofagitis por candida glabrata en el postoperatorio de una cirugia cardiaca hace 5 anos. Tras recibir tratamiento con varios antifu ngicos sin obtener resultado, acude a nuestra unidad por afagia. El transito baritado mostro engrosamientos nodulares, irregularidad de la superficie y crateres ulcerosos en la mucosa esofagica del tercio distal. La esofagogastroscopia, con toma de biopsias, revelo una estenosis en el tercio distal esofagico de aspecto fu ngico. Descartada la malignidad, se realizo una gastrostomia percutanea para evitar la malnutricion del paciente (fig. 1). c i r e s p . 2 0 1 5 ; 9 3 ( 1 ) : 4 2

The patient is a 75-year-old immunocompetent male who had been diagnosed with esophagitis due to Candida glabrata after cardiac surgery 5 years earlier. After receiving treatment with several different antifungal medications with no results, he was referred to our unit due to aphagia. Barium swallow study showed nodular thickening, irregular surface and ulcerous craters in the mucosa of the distal third of the esophagus. Esophagogastroscopy with biopsy revealed stenosis in the distal third of the esophagus with a fungal appearance. After having ruled out malignancy, percutaneous gastrostomy was used to avoid patient malnutrition (Fig. 1). c i r e s p . 2 0 1 5 ; 9 3 ( 1 ) : 4 2