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      Intususcepción colónica por leiomiosarcoma Translated title: Colonic intussusception by leiomyosarcoma

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          Abstract

          Reportamos el caso de una paciente mujer de 34 años, secretaria, con historia de anemia crónica y ovario poliquístico; sin historia familiar de cáncer. La paciente refería desde tres semanas antes del ingreso: náusea, vómito, dolor abdominal, fiebre y deposiciones sueltas con sangre. El dolor abdominal estaba localizado en flanco y fosa iliaca derecha, era tipo cólico, de intensidad 5/10 y asociado a distensión abdominal. En el examen clínico las funciones vitales indicaban T 38,6 °, FC 98 x min, FR 18 x min y PA 120/80; estaba despierta, lucida, pálida, en regular estado general. El abdomen estaba distendido, los ruidos hidroaéreos aumentados, timpánico a la percusión y con dolor a la palpación en hemiabdomen derecho (más intenso y con rebote positivo en fosa iliaca derecha); se palpaba masa de bordes no definidos en cuadrante inferior derecho, de aproximadamente 6cm. Diagnóstico clínico: Síndrome doloroso abdominal (¿plastrón apendicular, obstrucción intestinal: intususcepción?). En los exámenes auxiliares resaltaba la hemoglobina en 9,1 gr, con las constantes corpusculares disminuidas. El tacto rectal fue negativo, por lo que la colonoscopia fue diferida. Reevaluada a las 24 horas se decide cirugía. Se identificó una tumoración de colon transverso (con intususcepción colo-colónica), se resecó 10cm de colon y meso de tumoración; se realizó anastomosis T-T de colon transverso. La lesión era una tumoración proliferativa de 7x5 cm, que obstruía la luz del intestino casi totalmente. El estudio de anatomía patológica con inmunohistoquímica indicó que la lesión invaginada correspondía a un leiomiosarcoma de colon. Salió de alta en buenas condiciones. La rareza de éste tipo de neoplasia maligna de colon y lo esporádico de este tipo de presentación, nos indujo a realizar el presente reporte.

          Translated abstract

          We report the case of female patient, 34 years old, occupation Secretary. Background: Polycystic ovary and chronic anemia. No family history of cancer. The patient reported three weeks abdominal pain, fever, bloody loose stools, nausea and vomiting. Abdominal pain is located in flank and right lower quadrant, is colicky, intensity 5 / 10, associated with abdominal distension. On physical examination, vital functions indicated T 38.6 ° FC 98 x min, FR 18 x min, BP 120/80, was awake, she looked pale, in generally fair condition, lucid and oriented. The abdomen was distended, the increased bowel sounds, tympanic to percussion, with tenderness in the right abdomen (more intense in the right iliac fossa), palpable mass is not defined edges lower right quadrant of about 6cm. Clinical diagnosis: abdominal pain syndrome (appendicular mass, intestinal obstruction, intussusceptions). In examinations auxiliars highlighted in 9.1 g of hemoglobin with decreased corpuscular constants. Reviewed by history “rectal bleeding”, DRE: yellow stool, no trace of blood, so that colonoscopy was deferred. Reassessed at 24 hours, we decide surgery with a presumptive diagnosis of intestinal obstruction, intussusception. In surgery, we identified a transverse colon tumor (with colo-colonic intussusception) and 10cm of colon was resected and meso tumor: TT anastomosis was performed in transverse colon. The lesion was a tumor of the middle region of the transverse colon, proliferative fibroid appearance, which almost completely obstructed the intestinal lumen, measuring about 7x5cm. The study of pathology with immunohistochemistry indicated that the tumor corresponded to leiomyosarcoma of the colon. Was discharged in good condition. The rarity of this type of malignancy and this type of presentation led us to make this report.

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          Most cited references11

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          Adult intussusception

          In their study of adult intussusception, Sarma et al reported that, over a 6-year period, 15 patients with the disease were identified in a tertiary hospital in South India [1]. It would be of interest to know the total number of admissions or patients in the same hospital during the study period to be reported by the authors, so that estimates of the frequency rates of the disease could have been calculated. A cross-sectional study from Glasgow, UK, estimated the annual incidence of the disease to be 2-3 cases/106 population (accounted for <0.1% of hospital admissions) [2]. In a study from Switzerland, over a 17-year period, 10 adults with intussusception were recorded in three hospitals [3]. In this study, only 3 patients were diagnosed as ileocolic intussusceptions and 2 of them suffered from lymphoma. In another recently published study of 20 adult patients from Turkey, conducted over 8 years, 5 cases of jejunojejunal intussuception were identified, most of them due to Peutz-Jeghers hamartomatous polyps. In the same case-series study, rectal bleeding was reported only in 1 patient (5%) and acute symptoms (<4 days) in 6 patients (30%) [4]. These numbers are slightly different than those reported by Sarma et al and may indicate the diversity of the disease in different source populations. Finally, in the study of Sarma et al, no case of small bowel adenocarcinoma was diagnosed in 12 patients who underwent laparotomy, indicating the rarity of this type of tumor in the adult intussusception population. This finding is in accordance with the results of another retrospective review of 41 cases from China [5].
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            Leiomyosarcoma of the colon presenting as acute suppurative peritonitis.

            A surgical case of leiomyosarcoma arising from the ascending colon, presenting as acute suppurative peritonitis, is herein described. A 70-year-old woman complaining of lower abdominal pain presented to our clinic on October 12, 1994. She was admitted with a tentative diagnosis of peritonitis. At emergency laparatomy, purulent intraabdominal fluid was present, and a fist-sized mass was seen in the ascending colon just proximal to the hepatic flexure. A right hemicolectomy was thus performed based on a diagnosis of perforating colon cancer. The histologic findings were consistent with leiomyosarcoma with abscess formation in and around the tumor. Five mitotic figures per field were observed at 10x magnification. Immunohistochemical studies revealed immunoreactivity for alpha-smooth muscle antigen (alpha-SMA), vimentin, and desmin. After reviewing the clinicopathologic characteristics of colon leiomyosarcoma as described in 78 Japanese cases and 70 cases from the foreign literature, we thus propose that colon leiomyosarcoma frequently arises from the transverse colon. In addition, our case also represents the only reported case in Japan in which an adult patient underwent a successful operation for perforated leiomyosarcoma of the colon.
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              [A rare case of colonic invagination due to leiomyosarcoma].

              The authors report on a case of leiomyosarcoma with intussusception of the large bowel. They stress the importance of the clinical suspicion in targeting preoperative instrumental instrumental investigations.
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                Author and article information

                Journal
                rgp
                Revista de Gastroenterología del Perú
                Rev. gastroenterol. Perú
                Sociedad de Gastroenterología del Perú (Lima, , Peru )
                1022-5129
                July 2013
                : 33
                : 3
                : 251-254
                Affiliations
                [02] Lima orgnameHospital Nacional Edgardo Rebagliati Martins, EsSalud orgdiv1Departamento de Anatomía Patológica Perú
                [01] Lima orgnameHospital Nacional Edgardo Rebagliati Martins, EsSalud orgdiv1Departamento del Aparato Digestivo Perú
                Article
                S1022-51292013000300008 S1022-5129(13)03300300008
                d5849edc-fa2b-486c-985d-3b435267546b

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 21 August 2013
                : 20 November 2012
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 4
                Product

                SciELO Peru

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                Reporte de casos

                Leiomiosarcoma,Intususception,Intestinal obstruction,Leiomyosarcoma,Intususcepción,Obstrucción intestinal

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