RESUMO
Gallbladder cancer is a rare disease in Western developed countries, but it is a highly prevalent and lethal disease in Chile and other countries in Latin America. No randomized controlled trials have been performed in gallbladder cancer to establish standard treatments. We therefore performed the first Latin American consensus meeting for the management of gallbladder cancer. In this article we present the conclusions of the panel of experts for the palliative treatment of unresectable or metastatic gallbladder cancer based on a review of the literature, the discussion of the participating experts and the opinion of the assistants. The topics reviewed included: (1) Gallbladder cancer and cholangiocarcinoma--are they the same disease?; (2) Palliative chemotherapy: indications, drugs and schedules; (3) Palliative radiotherapy; (4) Palliative Surgery; (5) Management of malignant biliary obstruction.
Assuntos
Colangiocarcinoma/tratamento farmacológico , Neoplasias da Vesícula Biliar/tratamento farmacológico , Cuidados Paliativos , Neoplasias da Vesícula Biliar/secundário , Humanos , América Latina , Sociedades MédicasRESUMO
Gallbladder cancer is a rare disease in Western developed countries, but it is a highly prevalent and lethal disease in Chile and other countries in Latin America. No randomized controlled trials have been performed in gallbladder cancer to establish standard treatments. We therefore performed the first Latin American consensus meeting for the management of gallbladder cancer. In this article we present the conclusions of the panel of experts for the palliative treatment of unresectable or metastatic gallbladder cancer based on a review of the literature, the discussion of the participating experts and the opinion of the assistants. The topics reviewed included: 1.- Gallbladder Cancer and Cholangiocarcinoma -are they the same disease?; 2. - Palliative Chemotherapy: Indications, Drugs and Schedules; 3. - Palliative Radiotherapy; 4.- Palliative Surgery; 5.-Management of Malignant Biliary Obstruction.
Assuntos
Humanos , Colangiocarcinoma/tratamento farmacológico , Neoplasias da Vesícula Biliar/tratamento farmacológico , Cuidados Paliativos , Neoplasias da Vesícula Biliar/secundário , América Latina , Sociedades MédicasRESUMO
Breast cancer occurs primarily in women aged 25 years or older. Breast carcinoma has the potential for widespread dissemination, such as metastasis to axillary lymph nodes, bone, lung, pleura, brain, and soft tissues. Liver, gastrointestinal, and biliary tract involvement are infrequent. We report a patient, a 62-year-old woman, with symptomatic cholelithiasis. The patient proceeded to laparoscopic cholecystectomy. She had a previous history of mastectomy with axillary lymphadenectomy, performed for a breast ductal papillary carcinoma, 10 years prior to the cholecystectomy. The gallbladder was hydropic; the wall was thickened, with a focal broad-based lesion on the mesenteric face of the body. Histopathological evaluation of the focal broad-based lesion of the gallbladder revealed poorly differentiated adenocarcinoma infiltration, without mucosal involvement. Subsequent immunohistochemical examination showed the lesion to be cytokeratin 7(CK7)-positive and cytokeratin 20 (CK20)-negative. Estrogen receptor (ER) and progesterone receptor (PgR) were positive. The final pathological diagnosis was breast ductal papillary carcinoma metastases to the gallbladder. Mammography of the other breast was normal. Computed tomography (CT) scan of the brain, chest, abdomen, and pelvis was performed, without any pathological findings. Bone Tc-99 scintigraphy was normal. Six months after the surgery positron emission tomography (PET) showed no evidence of metastatic disease. Two years after the surgery, the patient died, in the absence of recurrence. A literature review revealed only a few more cases of metastasic breast carcinoma to the gallbladder.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Neoplasias da Vesícula Biliar/secundário , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Colecistectomia , Evolução Fatal , Feminino , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Mastectomia , Pessoa de Meia-IdadeRESUMO
Se presenta un caso de carcinoma mamario lobulillar que cinco años después presenta metástasis a vesícula biliar. La metástasis fue sospechada por el estudio histológico y confirmada por medio de inmunohistoquímica para receptores de estrógenos y progesterona.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Carcinoma Lobular/patologia , Neoplasias da Vesícula Biliar/etiologia , Neoplasias da Vesícula Biliar/secundário , Colangiografia , Colangiopancreatografia Retrógrada Endoscópica/métodosRESUMO
The metastasis in the extrahepatic digestive system are not very frequent and their characteristic is appearing after a long latent period, which takes 3 to 20 years, their symptoms are unspecific and appear to be inflammatory diseases or a second tumor. The most common histological subtype is the lobular carcinoma. Here we show you two cases of breast carcinoma metastasis, one in the ileum-colon and the other in the gallbladder. Both patient started showing symptoms, which led to the diagnosis was done in the surgical specimens where lobular carcinoma cells which infiltrated from the serosa to the mucosa were observed. The immunophenotype resulted to be BCA225, estrogen and progesterone positive. The treatment with radiotherapy, chemotherapy or hormonal therapy provides better life quality but the average chance of survival after the diagnosis is of a year.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Lobular/secundário , Neoplasias do Colo/secundário , Neoplasias da Vesícula Biliar/secundário , Neoplasias do Íleo/secundário , Doença Aguda , Carcinoma Lobular/diagnóstico , Colecistite/diagnóstico , Neoplasias do Colo/diagnóstico , Doença de Crohn/diagnóstico , Diagnóstico Diferencial , Feminino , Neoplasias da Vesícula Biliar/diagnóstico , Humanos , Neoplasias do Íleo/diagnóstico , Pessoa de Meia-IdadeRESUMO
Las metástasis en aparato digestivo, extrahepático son poco frecuentes y se caracterizan por presentarse luego de un período de latencia largo que va de 3 a 20 años, sus síntomas son inespecíficos y simulan enfermedades inflamatórias o segundo tumor. El subtipo histológico más común es el carcinoma lobulillar. Presentamos dos casos de metástasis de carcinoma de mama, uno en íleo-colon y otro en vesícula biliar. Ambas pacientes comenzaron con síntomas que llevaron a diagnósticos de enfermedad de Crohn en el primero y de colecistitis aguda en el caso dos. El diagnóstico se realizó en las piezas quirúrgicas, donde se observaron células de carcinoma lobulillar que infiltraban desde la serosa hasta la mucosa inclusive y con la inmunomarcación que resultaron BCA225, Estrógeno y Progesterona positivos. El tratamiento con radioterapia, quimioterapia u hormonal, mejora la calidad de vida, pero el promedio de sobrevida luego del diagnóstico es de un año.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama/patologia , Carcinoma Lobular/patologia , Neoplasias do Colo/secundário , Neoplasias da Vesícula Biliar/secundário , Íleo , Neoplasias Intestinais/secundário , Doença Aguda , Neoplasias da Mama/diagnóstico , Carcinoma Lobular/diagnóstico , Colecistite/diagnóstico , Neoplasias do Colo/diagnóstico , Doença de Crohn/diagnóstico , Diagnóstico Diferencial , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias Intestinais/diagnósticoRESUMO
Las metástasis en aparato digestivo, extrahepático son poco frecuentes y se caracterizan por presentarse luego de un período de latencia largo que va de 3 a 20 años, sus síntomas son inespecíficos y simulan enfermedades inflamatórias o segundo tumor. El subtipo histológico más común es el carcinoma lobulillar. Presentamos dos casos de metástasis de carcinoma de mama, uno en íleo-colon y otro en vesícula biliar. Ambas pacientes comenzaron con síntomas que llevaron a diagnósticos de enfermedad de Crohn en el primero y de colecistitis aguda en el caso dos. El diagnóstico se realizó en las piezas quirúrgicas, donde se observaron células de carcinoma lobulillar que infiltraban desde la serosa hasta la mucosa inclusive y con la inmunomarcación que resultaron BCA225, Estrógeno y Progesterona positivos. El tratamiento con radioterapia, quimioterapia u hormonal, mejora la calidad de vida, pero el promedio de sobrevida luego del diagnóstico es de un año. (AU)