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TEMÁRIO: CIRURGIA CITORREDUTORA / HIPEC disease, as well as the higher risk of postoperative CÓDIGO: 88345 complications.
CARDIOPHRENIC LYMPH NODES: WHAT IS Contato: Mariana Sousa Arakaki THEIR VALUE IN PATIENTS WITH PERITONEAL [email protected] CARCINOMATOSIS? WHAT CHANGES IN THE MANAGEMENT AND PROGNOSIS OF THESE TEMÁRIO: CIRURGIA CITORREDUTORA / HIPEC PATIENTS? CÓDIGO: 87883 Autores: Eduardo Hiroshi Akaishi / Akaishi, E. H. / Hospital das Clínicas da FMUSP; Mariana Sousa Arakaki CYTOREDUCTIVE SURGERY WITH CHEMO- / Arakaki, M. S. / Hospital das Clínicas da FMUSP; Helber THERAPY INTRAPERITONEAL HYPERTEN- Vidal Gadelha Lima / Lima, H. V. G. / Hospital das Clínicas SION (HIPEC) WITH PARTIAL HEPATECTOMY da FMUSP; Ivan Vinicius Andrade Galindo / Galindo, I. BY METASTATIC RIGHT COLON ADENOCAR- V. A. / A.C.Camargo Cancer Center; Lucas Afonso Daia CINOMA / Daia, L. A. / Hospital das Clínicas da FMUSP; Tomas Mansur Duarte de Miranda Marques / Marques, T. M. Autores: Matheus Pingerno dos Santos / SANTOS, M. D. M. / A.C.Camargo Cancer Center; Edivaldo Massazo P. / Universidade do Sul de Santa Catarina - UNISUL; Utiyama / Utiyama, E. M. / Hospital das Clínicas da Ariane Elias Antunes / ANTUNES, A. E / Universidade do FMUSP. Sul de Santa Catarina - UNISUL; Lucas Camargo Gamba Martins Do Amaral / AMARAL, L. C. G. M. / Universidade Introduction: Most primary tumors that occur within do Sul de Santa Catarina - UNISUL; Murilo Jebai the abdominal cavity can spread via hematogenous, Monteiro / MONTEIRO, M. J. / Universidade do Sul de lymphatic and peritoneal implantation. In the past, Santa Catarina - UNISUL; Italo Mattos Rinaldi / RINALDI, peritoneal carcinomatosis was considered fatal, I. M. / Universidade do Sul de Santa Catarina - UNISUL; causing intestinal obstruction and death in months Beatriz de Oliveira Kock / KOCK, B. O. / Universidade or years. Currently, in some types of tumors, in do Sul de Santa Catarina - UNISUL; Thamy dos Santos patients with exclusive peritoneal metastasis, surgical / SANTOS, T. / Hospital Nossa Senhora da Conceição; cytoreduction (CRS) with addition of hyperthermic Rayssa Pra Buss / BUSS, R. P. / Hospital Nossa Senhora intraperitoneal chemotherapy (HIPEC) may increase da Conceição; Cassiano Coral Accordi / ACCORDI, C. C. survival and provide a better quality of life. Following / Hospital Nossa Senhora da Conceição; Luiz Henrique Sugarbaker‘s publication in 1995 describing the CRS Locks Correa / Correa, L. H. L. / Hospital Nossa Senhora technique, many centers have gained competence da Conceição. to perform this procedure and consequently those patients who would die early, began to improve The Colorectal cancer (CCR) the most common neoplasia survival and with control of peritoneal disease, of the digestive tract and it has been observed in the dissemination to other sites (rarely seen previously), last few years that its incidence has been increasing; in such as cardiophrenic lymph nodes (CFLN), became Brazil is the fifth most commonly diagnosed malignancy important in several studies. CFLNs are considered and the fourth cause of death from cancer. Many factors as distant lymph nodes located in the space may be related, such as population aging, sedentary between the sternum, diaphragm and the heart. lifestyles and unhealthy eating habits. From 10 to 25% Objective: To discuss whether CFLN involvement has of patients with CCR develop distant metastasis to prognostic significance in patients with peritoneal the peritoneum. In this case report, we did object on carcinomatosis due to ovarian tumor. Show disease- this study describe the case of a patient underwent free survival (DFS) and postoperative complications in cytoreductive surgery and partial hepatectomy owing a series of patients. Method: We included patients to metastatic right colon adenocarcinoma for clinical with ovarian epithelial tumor who underwent CRS and presentations and clinical and surgical management. HIPEC, with histological confirmation of suspected Methods: This is an observational non-analytical CFLN, from 2002 to 2019. CFLNs were resected study. Results: ELM, 65 years-old, female, married. by transdiaphragmatic access during the surgical In mid-2018, the patient felt diffuse abdominal pain. procedure. Results: Four patients met the inclusion Abdominal US (08/2018) showed a massive right hepatic criteria: Case 1: 52 years, relapse disease, peritoneal lesion of 9.6 cm and a left annex heterogeneous image carcinomatosis index (PCI) 5, DFS 4 months, CFLN of 6.7 cm. Positive fecal occult blood testing (FOBT) and affected: 1. Case 2: 28 years, PCI 32, 2 reoperations, Ca 125 = 133. Abdominal CT (09/2018) showing 7.6 cm DFS 3 months, CFLN affected: 1. Case 3: 67 years, right hepatic lobe injury (S6, S7); expansive lesion in PCI 25, 1 reoperation, DFS 4 months, CFLN affected: the left annex with 8.5 cm involvement of the uterus. 1. Case 4: 68 years, PCI 29, 2 reoperations, DFS 10 Colonoscopy (09/2018) showed a neoplastic lesion in months, CFLN affected: 2. Conclusion: CRS with the cecum and the biopsy revealed an adenocarcinoma. HIPEC in patients with CFLN is questionable. Based The search for microsatellite instability was negative on the presented cases, in patients with malignant and mutation of the KRAS gene detected in codon ovarian neoplasia with peritoneal disease presenting 12. The patient was submitted to chemotherapy with suspicious CFLN, we suggest that a biopsy be with FOLFIRINOX. The diagnostic impression was of performed to histologically confirm the involvement right colon Adenocarcinoma with liver metastasis, of CFLN since, probably, the surgical procedure will ppendages and peritoneum. The procedure was surgical not benefit disease-free survival and prognosis of the cytoreduction with right partial colectomy, enlarged
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total hysterectomy for pelvic peritoneum, partial peritoneal macroscopic implants. Of the 2 patients hepatectomy (S6 / S7), cholecystectomy, omentectomy, with PM (3.4%), none of the lavages were positive. right diaphragm peritonectomy and parietal colic gutter Conclusion: The incidence of positive peritoneal lavage + HIPEC (Oxaliplatin) and right closed pleural drainage. reported in most studies ranges from 1.6% to 21%. This On postoperative physical examination, the patient is study had a low incidence of positive peritoneal lavage flushed, hypoactive and wandering, working ileostomy. (1.7%). The main factor that seems to be directly related Flaccid abdomen, painless, depressible, good looking to this low incidence of positive peritoneal lavage is the operative wound. In this case, the approach chosen for used cytological study methodology, with Papanicolaus the case is efficient because cytoreductive surgery with staining. For a better evaluation of peritoneal cytology, intra peritoneal hypertension chemotherapy (HIPEC) the staining techniques and histopathological evaluation for patients with peritoneal metastases in patients should be expanded. Patients will be followed up to with RCC has been shown to significantly improve the assess whether the cytology findings of peritoneal prognosis and quality of life of the patient compared lavage confer any oncologic prognostic factor. with chemotherapy or palliative approaches. Contato: Luiza dos Santos Menezes Contato: Matheus Pingerno dos Santos [email protected] [email protected]
TEMÁRIO: ONCOGINECOLOGIA TEMÁRIO: CIRURGIA CITORREDUTORA / HIPEC CÓDIGO: 87419 CÓDIGO: 88000 A CASE REPORT: PELVIC MASS AS ETIOLOGY INCIDENCE OF POSITIVE PERITONEAL OF NOT USUAL COMPLICATIONS CYTOLOGY IN COLORECTAL CANCER PATIENTS Autores: Ana Carolina Bathelt Fleig / Fleig, A. C. B. F. AT A REFERRAL HOSPITAL IN SALVADOR, / Hospital Santa Isabel; Guilherme Moreira Buchen / BRAZIL Buchen, G. M. / Hospital Santa Isabel; Mauricio Correa / Correa, M. / Hospital Santa Isabel; Yara Fernanda Autores: Cláudio de Almeida Quadros / Quadros, CA de Souza Neto / Neto, Y. F. S. / Hospital Santa Isabel; / Hospital Aristides Maltez; Emerson Prisco / Prisco, Raquel Bittencourt Catto / Catto, R. B. / Hospital Santa E. / Hospital Aristides Maltez; Mario Feitosa Falcão Isabel; Thayla Valderrama Bicheri / Bicheri, T. V. / / Falcão, M. F. / Hospital Aristides Maltez; Luiza dos Hospital Santa Isabel; Francielly Carine Marques Lauer / Santos Menezes / Menezes, L.S. / Hospital Aristides Lauer, F. C. M. / FURB; Bernardo Przysiezny / Przysiezny Maltez; Thiago Cardoso Matias / Matias, T.C. / Hospital / FURB; Willian Lorenzetti / Lorenzetti, W. / Hospital Aristides Maltez; Daniela Santos Mascarenhas Ribeiro / Santa Isabel; João Augusto dos Reis Guerra / Guerra, J. Mascarenhas, D.R. / Hospital Aristides Maltez; Antonina A. R. / Hospital Santa Isabel. Campos Silveira Machado / Machado, A.C. / Hospital Aristides Maltez. N.D, female, 68 anos, previously heatrlhy, has came to de ER with hipogastric abdominal pain associated Introduction: Peritoneal metastasis (PM) defines TNM wtih a previous trauma, a victim of running over with stage IV in patients with colorectal cancer (CRC). The low trauma cinematic two days ago. She evolved with treatment of this condition was restricted to palliative an abscess of abdominal muscle store in US, surgically chemotherapy. The survival of patients with undergoing drained and optimized with antibiotic therapy by 10 cytoreductive surgery with or without hyperthermic days. The paciente retorned to ER with fecaloid content intraperitoneal chemotherapychanged the treatment by the operative wound in the 05 post operatory day. paradigm. Although scientific data is still needed to Abdominal CT was done, showing enterocutaneous define consensus protocols. Published data defines that fistula and abscess of muscle abdominal wall, besides positive peritoneal cytology is a poor prognostic factor a extensive calcified right periovarian mass. Infeccious in gynecological, gastric and pancreatic cancer. But labs were detected. Exploratory laparotomy was data on the prognostic evidence of positive peritoneal made: rectocutaneous fistula, perforation in superior cytology in CRC are still controversial, altough 10% of recto, and a calcified mass at right anexial topografy, CRC patients have PM. Objectives: This study aims to suggesting an ovarian teratoma.. It was opted by a analyze the incidence of positive peritoneal cytology Hartmann rectosigmoidectomy, total histerectomy and in patients with CRC undergoing surgical treatment a bilateral salpingooforectomy. The pacient received in a cancer reference hospital. Methodology: This is hospital discharge after 17 days, with parentheral diet a prospective study conducted from October 2018 to and antibiotics. Biopsy: acute diverticulitis; extensive April 2019, based on the collection of peritoneal lavages calcified mass at right ovarium, without neoplasia before and after surgical resection, using Papanicolaus detected. Severian adenomiosis. Left ovarian with cytological technique, as well as the histopathological cistic endometriosis. Discussion: both diverticulitis and study of the resected specimens of CRC patients pelvic calcificated massesare capable to cause not usual undergoing surgical treatment. Results: 58 patients complications like fistula and abscess. The complications were included in the study. The average age was 60.1 of acute diverticulitis vary over usuals like perforations years. 33 (56.9%) of the tumors were in the colon and 25 and unusuals, as abscess, bleeding and fistula. The (43.1%) in the rectum. 16 (27.6%) patients had stage IV, present of fistula round about 14% after an episode 7 with livermetastases and 2 PM. Only one case (1.7%), of acute diverticulitis. Several differential diagnoses with stage IV disease, showed positive peritoneal can be cited for a inespecific pelvic mass, as a calcified cytology; the patient had liver metastases, but without
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tumor ( ovarian teratoma, for example), calcified commonly in young adults and children. Cervical STAS strange mass, calcified aneurism. The mature ovarian is extremely rare in the world literature. The most teratoma is the most common ovarian neoplasia. The common symptom is dysfunctional uterine bleeding. most commom complications can vay between torsion, Morphological differential diagnosis is important rupture, malignization and tumor infecction. The fistula for differentiation with other tumors. Therefore, an formation is extremelly rare, ocurring fewer than 1% immunohistochemical panel with epithelial, myogenic of the cases. The paciente in this case report present and neuroendocrine markers is fundamental for the exacerbation of diverticular disease after a abdominal diagnosis. In cases of cervical STAS, the prognosis is trauma, probably associated with the internal shock significantly better compared to other primary sites. of the calcified mass without definied etiology, whom Complete resection with adequate margins is the reach the fragiliy topografy of acute diverticular cornerstone of treatment for local control and cure disease. Conclusion: althought the etiology of ovarian of the disease. The role of radical hysterectomy is not calcification is not estalished, we notice excepcionality defined as long as it is possible to obtain free margins. on the case report because the rarity of the outcome as Chemo and radiotherapy have not been shown to be perforation and fistula after a abdominal trauma, with effective in STAS at other primary sites. acute diverticular disease exceraded with the internal shock with the pelvic calcified mass above described. Contato: Pedro Henrique Mendes Figueiredo [email protected] Contato: Ana Carolina Bathelt Fleig [email protected] TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 87346 TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 88146 ANGIOMIXOMA SUPERFICIAL DE VULVA - RELATO DE CASO ALVEOLAR SARCOMA OF THE CERVIX - RARE CASE AND LITERATURE REVIEW Autores: Bruno Gustavo dos Santos / Santos, B. G / UnB-HUB; Henrique Barbosa de Abreu / Abreu, H. B. Autores: Pedro Henrique Mendes Figueiredo / / UnB-HUB; Gustavo Antônio de Paula Prado / Prado, Figueiredo, P.H.M / Instituto de Oncologia Santa Paula; G. A. P. / UnB-HUB; Henrique Serra de Mello Martins Carolina Baraúna Assumpção / Assumpção, C.B. / / Martins, H. S. M. / UnB-HUB; Bruno Rosa de Souza / Hospital Geral de Guarulhos; Karla Calaça Kabbach Souza, B. R. / UnB-HUB; Viviane Rezende de Oliveira Prigenzi / Prigenzi, K.C.K. / Escola Paulista de Medicina; / Oliveira, V. R. / HUB; Amário Pires de Barros Júnior / Maximiliano Figueiredo / Figueiredo, M. / Hospital Geral Barros Junior, A. P. / HUB; Ceres Nunes de Resende / de Guarulhos; Luiz Maurício da Costa Correia / Correia, Resende, C. N. / HUB. L.M.C. / Hospital Geral de Guarulhos. Case Presentation: Patient A.C.A, 24 years old female, Introduction: Soft tissue alveolar sarcoma (STAS) is a nulligesta, presented to oncogynecology outpatient rare malignant neoplasm accounting for around 0.5- clinic with the chief complaints of two painless soft 1% of all cases of soft tissue sarcomas. STAS originating tissue consistency masses on the labia minora for from the female genital tract, including the cervix, are two years that became large polypoid lesions 5x5 extremely rare. We report a case of a young patient, cm without any inflammatory signs, along with 21 years old, with a vagina mass and dysmenorrhea, hyperkeratotic lesions on the clitorial region that gave which was diagnosed as STAS and referred to our the appearance of cracked land and commonly resulted gynecological oncology service. Case Report: A 21-year- in folliculitis. Moreover, she had many hyperpigmentary old woman with 4 month history of vaginal mass spots on crural region and armpit. Then, the patient got and dysmenorrhea was referred after “piece meal” gynecological, dermatological and genetic medicine resection of the vaginal mass diagnosed as cervical assistance for diagnostic clarification. The computed alveolar sarcoma. She was nulliparous, with no medical tomography and magnetic ressonance of abdomen history and no family history of cancer. Before being and pelvis didnt show any infiltrative abnormality or referred, the case was managed as a cervical polyp and lymph node enlargement. In November 27th, 2018, the later referred to our oncology service. Staging CT scans two polypoid lesions and the excess labia minora were showed no distant disease and all tumor markers were surgically removed, and a incisional biopsy of two lesions normal. Physical examination showed a 2.3 cm lesion in on the clitorial area was realized. The histopathological the lower lip of the cervix, well delimited, with no signs diagnosis was a superficial angiomyxoma of vulva. of invasion of the vaginal walls and no bleeding. After The definitive surgery treatment was performed in multidisciplinary discussion, it was decided to perform July 9th, 2019 and it consisted of a simple vulvectomy, radical hysterectomy with ovarian preservation and genital area reconstruction using remaing local tissues transposition. It was possible to obtain free margins. The and clitoris preservation. Discussion: The superficial final pathology report confirmed that it was STAS, with angiomyxoma is a rare benign neoplasia which consists immunohistochemistry marking TFE-3 and hormone in a aggregate of angiomyxoid nodules combined receptors. The patient received adjuvant radiotherapy with diffuse small and medium caliber blood vessels. and chemotherapy with good tolerance and has been It occurs more in men and usually affects extragenital without evidence of disease for 18 months. Follow-up regions. The treatment consists in the surgical excision is performed every 4 months with imaging and physical with a clear margin, as the case reported above. The examination. Discussion: This rare tumor occurs most most important differential diagnosis is the agressive
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angiomyxoma, which is more frequent, locally invasive survival. The presence of peritoneal implants and lymph and has high metastatic potential. In some cases, the node involvement occurs in about 35% of cases. In these, angiomyxoid nodules are related with a autosomal there is a higher risk of recurrence and evolution to dominant syndrome called Carneys complex , which low-grade invasive serous carcinoma. Only 5% of cases is associated with endocrinopathies, endocrine and affect the ovaries bilaterally. The conduct is surgical. neuroendocrine tumors. Final comments: The BST with volume above 1500cm³ is considered large, superficial angiomyxoma is a rare benign tumor and tumors larger than this are rarely described in the and the treatment consists in the complete surgical literature. The case has enormous potential for growth, excision. Although there are few cases reported about evidenced by the voluptuous mass removed by surgery. it, the exposed case shows its a important differential This surgical specimen is larger than the classification diagnosis of nodules on genital area associated with standards adopted as bulky in the literature. In addition, recurrent folliculitis. Besides that, this case shows its the bilateral presentation of the BST is uncommon possible to provide a complete surgical resolution and and it focused on the patient in an out-of-prevalence still to maintain the local aesthetics. age group. Final considerations The relevance of this case comes from the rare and high frequency bilateral Contato: Bruno Gustavo dos Santos involvement of the BST, besides of its presentation in [email protected] no-prevalent age group and out of menacme.
Contato: Lhorrainy Barboza Nogueira TEMÁRIO: ONCOGINECOLOGIA [email protected] CÓDIGO: 88027
BILATERAL BORDERLINE OVARIAN TUMOR: TEMÁRIO: ONCOGINECOLOGIA CASE REPORT CÓDIGO: 87300 Autores: Débora Viana Nunes / Nunes, D. N. / UFMT; CASE REPORT: DERMATOFIBROSARCOMA Débora Viana Nunes / Nunes, D. V. / UFMT; Lhorrainy PROTUBERANS IN GENITAL REGION Barboza Nogueira / Nogueira, L. B. / UFMT; Gabriella Marques Linaldi / Linaldi, G. M. / UFMT; Thiago Alves de Autores: Henrique Serra de Mello Martins / Martins, Souza / Souza, T. A. / UFMT; Gabriela Gondim Moura / H.S.M / UnB-HUB; Ceres Nunes de Resende / Resende, Moura, G. G. / UFMT; Lucas Silva Dias / Dias, L. S. / UFMT; C.N / UnB-HUB; Viviane Rezende de Oliveira / Oliveira, Letícia Helena Ferreira Montenegro / Montenegro, L. V.R / UnB-HUB; Amário Pires de Barros Júnior / Barros H. F. / UFMT; Gustavo Rondelo Duarte / Duarte, G. R. / Júnior, A.P / UnB-HUB; Bruno Gustavo dos Santos / Hospital de Câncer de Mato Grosso; Sheila Queiroz de Santos, B.G / UnB-HUB; Bruno Rosa de Souza / Souza, Campos / Campos, S. Q. / Hospital de Câncer de Mato B.R / UnB-HUB; Henrique Barbosa de Abreu / Abreu, H.B Grosso. / UnB-HUB; Gustavo Antônio de Paula Prado / Prado, G.A.P / UnB-HUB; Marcella Barreto Campos / Campos, Case Presentation A 58-year-old female patient M.B / Universidade Católica de Brasília; Thiago Almeida attended the outpatient clinic of Mato Grosso Hurtado / Hurtado, T.A / UniCEUB. Cancer Hospital for consultation, reporting increased abdominal volume for 1 year associated with moderate Case Introduction: Patient M.A.R, 75 years old, G3P2A1, abdominal pain. She also reported onset 6 months former smoker, sought medical attention in 2012. She ago of mild and progressive dyspnea associated with reported that in 2001 she had a history of nodule in increased abdominal volume. Contrast tomography of the right inguinal region which was removed, with no the abdomen and pelvis was requested for evaluation biopsy done. She now has a new nodule complaint in and delimitation of the mass, which evidenced two the right inguinal and vulvar region. It was brought a massive apparently cystic expansive contiguous histopathological report (HPR) that showed it to be a formations, rejecting the intestinal loops and bulging dermatofibrosarcoma protuberans (DFSP). Physical abdominal wall, being considered, among the diagnostic examination revealed a tumor in the right inguinal and possibilities, mesenteric cysts and ovarian neoplasia. vulvar region, wich was hardened, erythematous, and Based on the results, an ovarian tumor laparotomy painless. Tumor excision was performed through an was proposed, with intraoperative freezing biopsy. Two elliptical incision. The HPR showed it to be a DFSP, with masses were revealed, on the right side with 3,234cm³ compromised margins. No adjuvant chemotherapy (1,714g) and left side with 24,878cm³ (18,280g). The or radiotherapy was performed. It was assessed that anatomopathological diagnosis was benign Borderline a new surgical approach would be necessary, but the Serous Tumor (BST), therefore no lymphadenectomy is patients follow-up was lost by the hospital. The patient required. Patient evolved uneventfully postoperatively. returned in 2018, with recurrence of the lesion. Physical It was requested immunohistochemistry and the result examination revealed a large right lip lesion, 5 cm long, is awaited. Discussion BST represents 10-15% of ovarian of hardened and heterogeneous consistency, with neoplasia. It often affects women in menacme, most phlogistic signs, and multiple ulcerations, with discreet common at 40 years of age. The most important risk discharge of serous secretion. She had an incisional factor is the history, in addition to longer exposure to biopsy, which revealed it to be a DFSP. She was referred high estrogen levels (late menopause and menarche to the oncologic gynecology department where a radical precocious). The BST has a good prognosis, because right vulvectomy was performed, with reconstruction in general it remains limited to the ovaries, with low by a ipsilateral Gracile myocutaneous pedicled flap in invasive and growth potential, with 95-100% 10 years V-Y advancement. The HPR was of DFSP. The surgical
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margins were free of neoplasia. Patient had a good of squamous cell carcinoma; 1 case of adenocarcinoma, clinical evolution and was discharged in good general 1 case of adenosquamous carcionoma and 1 case of condition. Discussion: DFSP is a rare tumor with viloglandular adenocarcinoma. Regarding the initial potential for local invasion and recurrence. Its incidence therapeutic modality: 3 patients underwent only type III is higher in blacks and women, especially in individuals radical hysterectomy; 1 radical hysterectomy associated aged between 30 and 50 years. Most occur in the trunk, with brachytherapy(BT); 1 radical hysterectomy + BT followed by the upper, lower extremities, neck, and + Radiotherapy (RT); 8 performed Chemotherapy + RT head, rarely affecting the genitalia. Although relatively + BT. Although cervical cancer screening guidelines rare, it is the most common skin tumor of stromal point to the beginning of care coverage after the age of origin. The treatment is predominantly surgical, and the 25, a group of women develop Cervical cancer before complete removal of the tumor is recommended, with this age, especially with tumors that are advanced subsequent resections being necessary if the lesion has at the diagnosis. Some factors may be related to not been completely removed. Radiotherapy is mainly the pathological behavior of these patients: start of used in non-resectable cases. Final comments: DFSP is sexual activity, HPV virulence, multiplicity of partners. a tumor that, despite having an important potential for Therefore, it is up to the physician to pay attention to local invasion and recurrence, has surgical treatment the symptoms of malignant female genital tract and with a high chance of cure. Therefore, clinical follow-up to perform efficient actions for early diagnosis and in search of relapses and early treatment is necessary to treatment in order to improve the prognosis of these avoid cases such as the one cited, in which the patients patients, considering age, loss of reproductive capacity, quality of life was significantly reduced. hormonal disorders, interference with sexuality and disease progression. Contato: Henrique Serra de Mello Martins [email protected] Contato: Bruno Rosa de Souza [email protected]
TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 87320 TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 87297 CASE SERIES: FOLLOW UP OF INVASIVE CERVICAL CANCER IN PATIENTS UNDER 27 CASO REPORT: HIGH GRADE NEUROENDOCRINE YEARS OLD AT THE UNIVERSITY HOSPITAL OF CARCINOMA OF THE UTERINE CERVIX BRASÍLIA FROM 2009-2019 Autores: Henrique Serra de Mello Martins / Martins, H.S.M / UnB-HUB; Ceres Nunes de Resende / Resende, Autores: Bruno Rosa de Souza / Souza, B. R. / UnB/ C.N / UnB-HUB; Viviane Rezende de Oliveira / Oliveira, HUB; Viviane Rezende de Oliveira / Oliveira, V. R. / HUB; V.R / UnB-HUB; Amário Pires de Barros Júnior / Barro Gustavo Antônio de Paula Prado / Prado, G. A. P. / UnB/ Júnior, A.P / UnB-HUB; Marcella Barreto Campos / HUB; Bruno Gustavo dos Santos / Santos. B. S / UnB/ Campos, M.B / UnB-HUB; Thiago Almeida Hurtado / HUB; Henrique Serra de Mello Martins / Martins, H. Hurtado, T.A / UniCEUB; Bruno Rosa de Souza / Souza, S. M. / UnB/HUB; Jeanne Priscila Santos / Santos, J. P. B.R / UnB-HUB; Henrique Barbosa de Abreu / Abreu, H.B / Unb/HUB; Thiago Almeida Hurtado / Hurtado, T. A. / / Unb-HUB; Gustavo Antônio de Paula Prado / Prado, UniCEUB; Henrique Barbosa de Abreu / Abreu, H.B. / G.A.P / Unb-HUB; Bruno Gustavo dos Santos / Santos, UnB/HUB; Amário Pires de Barros Júnior / Barros Júnior, B.G / UnB-HUB. A. P. / HUB; Ceres Nunes de Resende / Resende, C. N. / HUB. Case Introduction: Patient L.O.S, 26 years old, G3P1A2, 5 previous sexual partners, underwent enlarged Cervical cancer is the third most common cancer in hysterectomy, bilateral salpingo-oophorectomy, bilateral Brazilian women, being the subject of public policies and retroperitoneal pelvic lymphadenectomy, due to for early screening. The cervical cytology, the main preoperative cervical carcinoma. Histopathological screening strategy for cervical cancer, is recommended and immunohistochemical examination revealed the by the health ministry to be performed after 25 years diagnosis of high-grade neuroendocrine carcinoma of age, thus leaving a younger population out of its in the cervix. A sample sent to the pathology service coverage. This study aims to evaluate patients under 27 showed a tumor with dimensions of 1.5x1.0x0.4cm, of years old with cervical cancer, treated at the Gynecologic high grade neuroendocrine cancer type, histological oncology Reference Service, in the period of 2009-2019, grade 3, with stromal invasion, without compromising regarding: age at diagnosis; histological type of tumor; other adjacent organs / tissues. It was associated with a staging and initial treatment. This is a retrospective high grade intraepithelial neoplasia (carcinoma in situ) of study conducted through a survey of medical records the cervix. Pathological status by FIGO was IB1, and AJCC of patients diagnosed with invasive cervical cancer staging of pT1b1pN0. The immunohistochemical report followed at the gynecological oncology outpatient of the was positive for chromagranin (A poly), synaptophysine University Hospital of Brasilia between 2009-2019 with (DAK-SYNAP) positive and 90% Ki-67 (MIB 1), covered a diagnosis before 27 years old. In all, 13 patients with with high-grade cervical carcinoma neuroendocrine. this profile were diagnosed. Of the 13 patients analyzed, Discussion: Neuroendocrine tumors are typically the average age at diagnosis was 24.38 years old, with located in the gastrointestinal tract, pancreas, lung and a standard deviation of 1.595; the oldest was 26 years, are subdivided into well-differentiated, and poorly- the youngest was 21; as for staging: 2 cases IB1; 3 IB2; 1 differentiated. They rarely occur in other organs, such IIA; 4 IIB and 3 IIIB; Regarding histological type: 11 cases as the female genital. Uterine cervical neuroendocrine
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carcinoma is an aggressive histological variant of cervical rate of 0.84% (± 0.11) per year, while the extended radical cancer, the most common type being of small cell. The technique did so with a rate of 4.4% (± 0.17) per year diagnosis can be made with immunohistochemistry, (p<0.01). Also, the COR hysterectomies had an annual with markers of chrommaganine, synaptophysine, CD56, average of 6.7±0.37 days of hospitalization, while the with the positivity of two of these being recommended. extended radical technique showed an annual average Treatment is based on a multimodal approach, with of 4.2±0.33 days, representing a 2-days early discharge, radical surgery indicated in the stages associated with on average (p<0.01). In mortality rate, the COR technique neoadjuvant or adjuvant chemotherapy. In advanced showed an average growth of 45.6%±0.23 per year, and stages, chemoradiotherapy and chemotherapy are this was significantly higher (p<0.01) when compared recommended. There are no treatment schemes based to the average annual growth of 4.3%±0.73 of the on evidence do to the rarity of this condition. The extended radical technique. Regarding costs, there was prognosis remains reserved, regardless of the treatment no correlation between techniques and their expenses adopted. Final considerations Cervical neuroendocrine (p=0.78), whose COR hysterectomy cost, by procedure, carcinoma is an extremely rare condition, accounting an annual average of R$ 5,317.78 (±1,777.6) and the for about 2% of neoplasms in this region. Do to its extended radical, R$ 5,089.01 (±1,777.6). Conclusion: rarity, the most appropriate treatment is not yet well Our study suggests that the COR hysterectomy has established. Therefore, the present case is relevant for significantly negative impacts on the patients evolution, informing the medical community about the pathology with a longer hospitalization time, probably related to and contributing to its better understanding. higher morbidity associated with resection of multiple organs, besides lower survival rate, possibly associated Contato: Henrique Serra de Mello Martins with more advanced staging. Moreover, it is inferred [email protected] that the precise diagnosis of each underlying disease would be relevant to better understand the treatment- prognostic, intimate correlates of these surgical TEMÁRIO: ONCOGINECOLOGIA interventions in oncology. CÓDIGO: 88145 Contato: André Bouzas de Andrade COMPARATIVE ANALYSIS OF THE SURGICAL [email protected] TREATMENT FOR UTERINE CANCER:
EXTENDED RADICAL HYSTERECTOMY VERSUS TEMÁRIO: ONCOGINECOLOGIA HYSTERECTOMY WITH CONTIGUOUS ORGAN CÓDIGO: 87774 RESECTION Autores: Adriano Tito Souza Vieira / Vieira, A. T. S. CONDUCTS EVALUATION AND Case / UNEB; João Henrique Fonseca Do Nascimento / Presentation OF CERVICAL CANCER IN Nascimento, J. H. F. / UNEB; Benjamim Messias de Souza PREGNANT WITH SECOND TRIMESTER Filho / Souza Filho, B. M. / UNEB; Selton Cavalcante Autores: Marcos Antônio Lima Carvalho / Carvalho, Tomaz / Tomaz, S. C. / UNEB; Ronald Enrique Delgado M. A. L. / Universidade Federal de Sergipe; João Bocanegra / Delgado-Bocanegra, R. E. / HSI; Vítor Sávio Eduardo Andrade Tavares de Aguiar / Aguiar, J. E. A. Melo Costa / Costa, V. S. M. / HSI; Luís Fernando Pinto T. / Universidade Federal de Sergipe; Roberto Queiroz Johnson / Johnson, L. F. P. / HSI; André Gusmão Cunha / Gurgel / Gurgel, R. Q. / Fundação Beneficência Hospital Cunha, A. G. / UNEB, UFBA; André Bouzas de Andrade / do Cirurgia. Andrade, A. B. / UNEB, HSI. Presentation: Woman, 37 years, pregnant, with Introduction: The choice of the technique is a decision gestational age (GA) of 20 weeks, resident of Aracaju-SE, that can directly determine the outcome and prognosis searched for a surgical oncologys service after the result of several surgical pathologies, such as uterine cancer. of moderately differentiated squamous cell carcinoma, In this context, two important techniques are common infiltrative and eroded, viewed on anatomopathological and often applied in Brazil, coded by the Brazilian examination of uterine cervix. Discussion: The cervical health system as extended radical hysterectomy and cancer occurs in 1 of 1000 gestations and consists in half hysterectomy with contiguous organ resection (COR). of neoplasms diagnosed during pregnancy. Frequently, Furthermore, it is crucial to understand the impacts of the diagnosis of cancer in pregnant women is late these techniques on public health, to identify potential because of: rarity of the disease, anatomophysiological ways to minimize damage, optimize recovery and ensure alterations that prejudice the cervical exam; and better outcomes. Objective: To conduct a comparative the similarity between the signals and symptoms of public epidemiological investigation between pregnancy and that pathology. The conduct after the techniques in hysterectomies related to oncologic discovery should be evaluated in accord with the GA surgery. Method: Epidemiological study, performed during diagnosis, the stage of the disease, the size of under analysis in DATASUS (SIH/SUS and SISCOLO/SUS), tumor, the patients wish of keeping pregnancy and in the period 2009 to 2018. The statistical analysis was future reproductive capacity. In carcinomas, there is no ran on the platform OpenEpi 3.01 (MIT/USA) and p<0.01 evidences that the gestation accelerates the diseases was considered significant. Results: During 2009- evolution. The GA has a huge impact on the chosen 2018, the extended radical oncologic hysterectomies conduct. Before the 20º week, the treatment must be computed 33,692 operations, being 8.7 times higher immediate, because waiting for the end of pregnancy than the oncological hysterectomies COR (p<0.01) 3,880 can improve morbimortality. After this period, the fetal procedures. The ratio of COR hysterectomies grew at a
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lung maturity must be awaited to initiate treatment, lobulated flap and closure suture in two planes were because literature demonstrates that the defer of performed. Pathologically, it resulted from a benign treatment in these cases dont affect the maternal mesenchymal lesion characterized by proliferation prognosis. However, there is a huge divergence on the of connective tissue with thick collagen fibers in the limit of GA to determinate the wait for fetal maturity or middle and absence of significant atypia with mitotic to begin treatment. The values variate from 12º to 20º index from 0 to 1 mitosis in 10 cga, with no necrosis week. In this patients case, the diagnosis was made on and typical overlying epidermis, without evidence the second trimester. As the literature shows a doubt viral cytopathic effect and free resection margins. In about the limit GA for waiting the fetal maturation, immunohistochemistry, a mesenchymal lesion was the chosen conduct was accepting the patients wish found showing nuclear positivity for beta-catenin in to continue the pregnancy. However, it was found an storiform areas, with positivity for smooth muscle improvement of maternal morbimortality for pregnants markers in muscle fiber bundles and S-100 protein in with GA until 20 weeks. Thus, the chosen approach was typical mature adipocytes. The morphological pattern to wait for the 28º week to accelerate the fetal lung associated with immunohistochemical study favors the maturity and to perform a cesarean associated with a diagnosis of cutaneous Hamartoma or Fibromatosis, definitive surgery for the tumor. Final comments: The due to areas of nuclear positivity for beta-catenin, with treatment options are variable. However, each case no malignancy criteria. The postoperative period was must be individually evaluated, taking into consideration considered optimal and adhesive gel slides were used the GA, the stage of disease and the patients desire. It is as a prophylactic measure of new keloid without the important the knowledge of management in neoplasms need for local corticosteroid injection. during pregnancy whereas there is little experience of professionals in handling this especial kind of patient. Contato: Gustavo de Assis Gobetti Lastly, besides the chemotherapy offers risks to the [email protected] fetal health, it is necessary to evaluate the risks to maternal life. TEMÁRIO: ONCOGINECOLOGIA Contato: Marcos Antônio Lima Carvalho CÓDIGO: 87752 [email protected] CYTOREDUCTIVE SURGERY ASSOCIATED WITH CHEMOTHERAPY INCREASING THE TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 87267 SURVIVAL OF PATIENTS WITH HIGH-GRADE SEROUS CARCINOMA: A CASE REPORT CUTANEOUS HAMARTOMA LIKE GIANT Autores: Barbara Paulo Cavalcante / Cavalcante, B. P. CONDILOMA IN PUBIAN REGION / Universidade Potiguar; Thiago Costa Pires / Pires, T. C. / Liga Norte Riograndense Contra o Câncer; Gustavo Autores: Gustavo de Assis Gobetti / Gobetti, G. A. / Torres Lopes Santos / Santos, G. T. L / Liga Norte Hospital do Câncer de Londrina; José D‘oliveira Couto Riograndense Contra o Câncer; André Luiz Costa e Silva Filho / Couto Filho, J. O. / Hospital do Câncer de Londrina; / Silva, A. L. C / Universidade Federal do Rio Grande Francisco Carlos de Oliveira Lopes / Lopes, F. C. O. / do Norte; Amanda Barbetto Medeiros Torres / Torres, Hospital do Câncer de Londrina; Kelli Fernanda Pereira A. B. M. / Universidade Potiguar; Marina Fernandes / e Silva / Silva, K. F. P. / Hospital do Câncer de Londrina; Fernandes, M. / Universidade Potiguar; Renata Beatriz Maria Cristina Bertan / Bertan, M. C. / Hospital do Bessa Teixeira / Teixeira, R. B. B. / Universidade Câncer de Londrina; Maria Cristina Soubhia / Soubhia, Potiguar; Juliana Maria Caetano Nogueira / Nogueira, J. M. C. / Hospital do Câncer de Londrina; Bruno André Di M. C. / Universidade Potiguar; Víctor José Negreiros de Rico / Di Rico, B. A. / Hospital do Câncer de Londrina; Sá Rosado / Rosado, V. J. N. S. / Universidade Potiguar; Thiago Astorga Martins / Martins, T. A, / Hospital do Pedro de Albuquerque Mafaldo / Mafaldo, P. A. / Câncer de Londrina; George Camara Lopes / Lopes. Universidade Potiguar. G. C. / Hospital do Câncer de Londrina; Gabriel Villas- bôas dos Santos Tabosa / Tabosa, G. V. S. / Hospital do Case Presentation: A.F.L., female, 56-years-old, Câncer de Londrina. admitted in April 2015 with increased abdominal volume for three weeks, associated with pain Condyloma, caused by Human Papilloma Virus (HPV), is and progressive postprandial fullness. Computed a sexually disease transmitted and in the pubic region tomography (CT) revealed a pelvic mass affecting the is very common. We report the case of an 18-year-old right ovary, moderate ascites, and abdominal wall female patient who was referred to the Gynecological nodules, suggesting peritoneal carcinomatosis, CA Oncology referral hospital for clinical suspicion of giant 125 639.7. Laparotomy (EL) performed with multiple condyloma in the pubic region. This lesion started seven biopsies and right adnexectomy. Pathology (PA) months before the consultation and grew rapidly. As a revealed ovarian high-grade serous carcinoma (HGSC), medical history, healthy patient, without continuous neoplastic implants in the omentum, peritoneum, medication and history of keloids in previous scars. As mesentery, mesocolon and malignant positive ascitic an obstetric antecedent, she had a pregnancy with fetal fluid. Neoadjuvant chemotherapy started with Taxol and death due to alleged thrombophilia. The lesion was Carboplatin for 06 cycles. In November 2015, performed midline in the pubic region, measuring approximately complete cytoreduction. PA: complete pathological 10 cm and with clinical features of giant condyloma. response. In December 2016, magnetic resonance Resection of the lesion and reconstruction with imaging showed iliac lymph node enlargement, and
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PET-CT pointed a nodule near the inferior pole of the by the Research Ethics Committee of the University spleen, suggesting recurrence. EL performed in March of Cruz Alta, according to the document number 2017 revealed that the nodule was in the transverse 2,354,150 Results: Of the 227 patients evaluated, 68 colon, resecting it; PA confirmed recurrences in (30%) had initial lesions, 151 (68%) had locally advanced lymph nodes and colon. A search requested for BRCA tumors, and eight (3.5%) were identified with visceral 1 and 2, negative result. She started new adjuvant metastases. Conclusions: Our survey showed that chemotherapy treatment. In September 2018, a CT scan 71.5% of the cervical cancer cases were admitted in of the abdomen indicated a perirectal heterogeneous advanced stages. This suggests that there is a weakness lesion suspicious for recurrence. In January 2019, a new in the preventative care system and a lack of knowledge surgery with pararectal mass en bloc resection with about the importance of screening tests among the the intestinal wall, PA: positive for metastatic HGSC. affected women. The patient follows treatment by clinical oncology with bevacizumab, carboplatin, and gemcitabine, with Contato: Lucas Adalberto Geraldi Zanini no evidence of disease. Discussion: Ovarian cancer [email protected] is the most lethal gynecological neoplasia, frequently histological type being the HGSC. Age over 50 years, menopause, tumors of histological grade 2 or 3, stage TEMÁRIO: ONCOGINECOLOGIA II to IV, and positive peritoneal cytology are significant CÓDIGO: 88246 factors of worse prognosis, all of which are present in the case. Due to the lack of specific signs and symptoms, ENDOCERVICAL GASTRIC-TYPE MUCINOUS ovarian carcinomas remain diagnosed at advanced CARCINOMA, CASE REPORT stages in most cases. Final considerations:HGSC is one of the most aggressive histological types of Autores: Paula Daphne Brisigueli Borges de Almeida / ovarian cancer when combined with age higher than 50 de Almeida, P. D. B. B. / Hospital de Cancer de Barretos; years, menopause, stages II-IV, and positive peritoneal Ricardo dos Reis / dos Reis, R. / Hospital de Cancer de cytology. Although the literature shows that survival Barretos; Carlos Eduardo Mattos da Cunha Andrade / in these cases is less than 18 months, the patient has Andrade, C. E. M. C. / Hospital de Cancer de Barretos; been for more than 48 months on alternate treatments Rafael Vilá Moura / Moura, R. V. / Hospital de Cancer between surgery and chemotherapy. In such cases, de Barretos; Ronaldo Luis Schmidt / Schmidt, R. L. / radical surgery as complete cytoreduction associated Hospital de Cancer de Barretos; Marcelo de Andrade with chemical treatment can increase survival Vieira / Vieira, M. A. / Hospital de Cancer de Barretos; considerably. Leandro de Medeiros Nóbrega / Nóbrega, L.M. / Hospital de Cancer de Barretos. Contato: Barbara Paulo Cavalcante [email protected] Case preparation: A 59 years old women, G2P2, had a medical examination for a pap smear undertaken in a different clinic that showed adenocarcinoma ïn situ, in TEMÁRIO: ONCOGINECOLOGIA May 2017. Her physical exam, at the time of adimission, CÓDIGO: 88379 colposcopy and cervix biopsy prove to be normal and high risk-HPV (hr-HPV) test was negative. Our pathology DISTRIBUTION OF CERVICAL CANCER CASES team reviewed her previous pap-smear and obtain AT A HIGH COMPLEXITY ONCOLOGY CENTER as result a atypical squamous cells of undetermined significance (ASCUS). She maintained regular medical Autores: Lucas Adalberto Geraldi Zanini / Zanini, L.A.G. consults and exams without abnormalities until / CACON - IJUÍ-RS; Janice de Fátima Pavan Zanella / february 2019 when the colposcopy showed a aceto- Zanella, J.F.P. / UNICRUZ - Cruz Alta RS; Graciele Meriane white and hypervascular lesion in the cervix with a Machado / Machado, G.M. / UNICRUZ - Cruz Alta RS. correspondent biopsy revealing a chronic inflamation of the cervix. Therefore she was submitted to a cervix Introduction: Cervical cancer is the fourth most conization that showed a well-differentiated gastric- frequent neoplasm in the female population in the type mucinous carcinoma. A Magnetic Ressonance world. Approximately 70% of this type of cancer occurs Imaging (MRI) was performed revealing a invasive in less developed countries, where the risk of death is lesion with restricted-diffusion an initial parametrium three times higher. Although cervical cancer screening invasion. Her final stage was IIB according to the latest programs are proven to be effective and available to FIGO cervical câncer stagin. Our patient is been treated the female population, 60% of cervical neoplasms are with chemoradiotherapy. Discussion: The Endocervical- diagnosed at advanced stages in Brazil. Objective: To type mucinous adenocarcinoma (ECA) is an entity who report the distribution of cervical cancer cases treated has been more in evidence in the last 20 years. Althout at a high complexity oncology center. Methods: A is considered rare in western countries, in Japan, ECA retrospective cohort from January 2011 to December represent up to 20% of all endocervical carcinomas. 2017 was carried out at the High Complexity Oncology Since 2014 the World Health Organization classified the Center of Ijuí, Ijuí, state of Rio Grande do Sul, Brazil. ECA as a group incluing the gastric-type adenocarcinoma Patients with invasive cervical neoplasms were included. of the cervix (GAS), and it is caracterized as a hr-HPV The cases were staged according to the International negative disease, with the diagnosis based on glandular Federation of Gynecology and Obstetrics (2018) in epithelium resembling gastric foveolar and pyloric initial (IA1, IA2, IB1, IB2, IIA1), locally advanced (IB3, IIA2, epithelium, abundant eosinophilic cytoplasm, different III, IVA), or metastatic (IVB). This study was approved from a usual basophilic cytoplasm of the endocervical
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glands. In a colposcopy the hallmark for diagnostic The abdominal wall is one of the most frequent a cervical neoplasia is the identification of a dense, extraperitoneal locations, resulting from direct opaque acetowhite well demarcated area after 5% implantation of endometrial cells after surgical acetic acid aplication. The most common MRI finding is incisions. Endometriosis associated abdominal wall an invasive solid or a diffuse infiltrative pattern. GAS is cancer (EAAWC) is rare. It has been related only around a rare entity that has been showed to be an aggressive 30 times on the literature. Lesions growth is slow and type with a poor prognosis, once a large percentage of typical presentation is the onset of abdominal pain the patients presented at an advanced stage and pelvic, and palpable mass. The most common histologic type abdominal, also distant metastases are common. Final is clear cell carcinoma. Treatment is based on surgical coments: GAS is a rare type of cervical cancer with staging and debulking and adjuvant chemotherapy. hr-HPV negative, so it could pass unnoticed unless a The prognosis is poor, with a mean overall survival of carrefully investigation is performed. The colposcopy 30 months. Final comments Endometriosis associated remains an indispensable tool in the cervical cancer abdominal wall cancer (EAAWC) is a rare condition, with surveillance. agressive behaviour and poor prognosis. The limited amount of reports on the literature complicates the Contato: Paula Daphne Brisigueli Borges de Almeida analysis of medium and long-term survival. Clinical [email protected] follow up and documentation of results, both positive and negative, are essential for a better understanding of this disease. TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 87239 Contato: Vinicius Humberto de Souza Vicuña [email protected] ENDOMETRIOID ADENOCARCINOMA ARISING FROM ABDOMINAL WALL ENDOMETRIOSIS: A TEMÁRIO: ONCOGINECOLOGIA CASE REPORT CÓDIGO: 88256 Autores: Vinicius Humberto de Souza Vicuña / Vicuña, V.H. / INCA; Gustavo Carvalho / Carvalho, G. / Instituto FALLOPIAN TUBE CARCINOMA - CASE REPORT Nacional de Câncer - INCA; Ketheryn Adna Souza de Autores: Wilson Garcia Pereira / Pereira, W.G. / UNEMAT; Almeida / Almeida, K. / Instituto Nacional de Câncer Fernanda Garcia de Carvalho Pereira / Pereira, F. G. C. - INCA; Vitor Delucas Santana / Delucas, V. / Instituto / ; Oliver Guilherme da Silva / da Silva, O. G, / ; Luiza Nacional de Câncer - INCA; Jose Ricardo Conte de Souza Cupertino Bérgomi / Bérgomi, L. C. / . / Souza, J. R. / Instituto Nacional de Câncer - INCA; Brian de Carvalho Silvestre / Silvestre, B. / Instituto Nacional de Câncer - INCA; Juliana Coelho / Coelho, J. / Instituto A 46-year-old woman with 3 births, who underwent Nacional de Câncer - INCA; Lucas Simões / Simões, L. / hysterectomy with unilateral salpingo-oophorectomy, Instituto Nacional de Câncer - INCA. is referred to oncologic surgeon after pathology showing malignancy, bringing the following tests: 1 - Transvaginal ultrasound with uterus of 234 cm³, right Case Presentation: We present a case of a 45 years ovary cyst with trabeculations and irregular contours old female with a past medical history of a right of 3.4 mm and echogenic image of 2.8 cm; 2 - Pelvic colectomy for a benign tumor, who presents with a magnetic resonance with serpiginous cystic image in periumbilical lesion with progressive growth in the the right adnexal region with partial septations (up last year. On physical examination she presented two to 2.2 cm in diameter) and some nodular irregularity abdominal masses, one located in the right lower inside with high diffusion signal and early post-contrast quadrant, apparently originated from the abdominal enhancement measuring 3.5 x 2 , 7 x 2.7 cm suspected wall, and the other located in the left lower quadrant, for fallopian tube neoplasia; 3 - Anatomopathological probably emerging from the pelvis. CT scan revealed showing right tubule covered with swollen, congestive a heterogeneous mass, measuring 18x16x9 cm, serosa, with adhered cystic formations and 2 x 1.9 cm originating from the uterus, and other lesion measuring whitish solid formation compatible with high-grade 5x4x5 cm located on the abdominal wall, at the level of serous carcinoma restricted to right fallopian tube with the mesogastrium. Tru-cut and incisional biopsies were narrow radial margins (less than 1 mm). Transvaginal taken, but both were inconclusive. We decided, then, to ultrasound already defines the surgical approach. perform primary resection. We performed an abdominal However, resonance or computed tomography wall resection, total hysterectomy and bilateral salpingo- serves to better evaluate the connexion of mass with oophorectomy. The abdominal wall was reconstructed adjacent structures, as well as to evaluate lymph with a Proceed mesh. Histopathology revealed: node enlargement and peritoneal dissemination. The On the abdominal wall- Moderately differentiated staging of fallopian tube cancer and ovarian cancer is endometrioid adenocarcinoma arising from an surgical. Exploratory laparotomy was indicated due endometriosis implant; Uterus and ovaries: Multifocal, to incomplete staging, presence of high-grade serous intramucosal, well differentiated endometrioid adenocarcinoma and preservation of the contralateral adenocarcinoma, plus several leiomyomas measuring ovary. CA 125 of 63.2 U/ml was also requested, which up to 10 cm. Post operative evolution was satisfactory. is useful as a marker of response degree to treatment Patient received adjuvant megestat, and is now on and relapses during follow-up. In the surgery, three follow up in good condition. Discussion: Endometriosis suspicious lymph nodes were found next to the common is a benign condition characterized by the presence iliac vessels on the right and laterally to the bifurcation of endometrial stroma and glands outside the uterus. of aorta, whose freezing was positive for carcinoma.
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Left ovary and remaining abdominal cavity didnt have case under discussion, it was decided to continue the evidence of disease. Pelvic and infrarenal intercaval- pregnancy and intervene already in the act of cesarean aortic lymphadenectomy was performed together with section, with debulking 3 weeks later. Management inframesocolic omentectomy and diffuse peritoneal of ovarian neoplasia in pregnancy is governed by the biopsies. Pathology confirmed neoplastic infiltration gestational trimester. In the first trimester, a consensus only in three ganglia (16 resected) and the remaining should be reached between the patient and staff if the disease free. Since it is staged as IIIC fallopian tube patient wishes to continue pregnancy and preserve carcinoma, adjuvant chemotherapy is indicated. The fertility, the stage and histopathology of the disease will presentation of this case reinforces the similar behavior determine the treatment plan. In the second trimester, between ovarian and fallopian carcinomas. The need for chemotherapy may be considered for patients with their differentiation in the adnexal pelvic masses is of sensitivity to chemotherapy. However, in the third fundamental importance and should be addressed by trimester, cesarean section procedure is considered a specialist surgeon, avoiding late diagnosis, worsening including cytoreductive surgery performed at the same prognosis and increased morbidity and mortality. time or after. Conclusion: The management of ovarian malignant tumors in pregnancy is delicate, and the Contato: Wilson Garcia Pereira patients desire should be considered as the gestational [email protected] trimester to make the best therapeutic decision.
Contato: Maryory Adriana Sánchez Garcia TEMÁRIO: ONCOGINECOLOGIA [email protected] CÓDIGO: 88182
GESTATION AND OVARIAN ADENOCARCINOMA TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 85105 Autores: Maryory Adriana Sánchez Garcia / Garcia, MAS / Santa Casa de Porto Alegre; Gustavo Andreazza GIANT MUCINOUS OVARIAN CYSTADENOMA: Laporte / Laporte, GA / Santa Casa de Porto Alegre; Rosilene Jara Reis / Reis, RJ / Santa Casa de Porto Alegre; A CASE REPORT Angelo Tasca / Tasca, A / Hospital Moinhos de Vento; Autores: Jorge Antonio álvarez Barrientos / Barrientos, Maria Ines Iankowski dos Santos Saraiva / Saraiva, MIIS J.A.A / Universidad Internacional Tres Fronteras- / Hospital Moinhos de Vento; Jose Rossari / Rossari / UNINTER; Raphael Oliveira Ramos Franco Netto / Franco Hospital Moinhos de Vento; Ruth Karina Escobar Díaz Netto, R.O.R / Universidad Internacional Tres Fronteras- / Diaz, RKE / Santa Casa de Porto Alegre; Davi Carlos UNINTER; Juliana de Almeida Rodrigues Franco Netto Brun / Brun, DC / Santa Casa de Porto Alegre; Moacyr / Franco Netto, J.A.R / Universidad Internacional Tres Christopher Garces Gamarra Salem / Salem, MCGG / Fronteras-UNINTER. Santa Casa de Porto Alegre; Guilherme Zatti Fedrizzi / Fedrizzi, GZ / Santa Casa de Porto Alegre. Case Report: A 61-year-old female patient entered the emergency department presenting severe pain Introduction: Ovarian cancer is the second with the in the pelvic region, difficulty walking and increased highest incidence in pregnancy, the adnexal masses abdominal volume. Total abdomen CT scan showed diagnosed in pregnancy, in the largest proportion extensive cystic hypodense ovate expansive tumor are benign (1: 10,000), however malignant tumors lesion occupying much of the abdominal cavity. CA-125 correspond to 20% of these. Description of a case of an tumor markers increased and CEA within reference ovarian tumor in pregnancy and review the literature. values. Exploratory laparotomy was performed, with Methodology: A 40-year-old G2P2C1 (4a) patient with xifopubian incision and salpingo-oophorectomy on 8-week USG with evidence of left adnexal mass with the left. Pathological analysis showed macroscopically solid areas and presence of septa. At 28 weeks MRI: Left cystoadenoma mucinosa of the left ovary with ovary: difficult to delineate, heterogeneous lesion, well- intact capsule measuring 33x28x20 cm in diameter, delimited 13.8 x 12.7 x 7.9 cm, 720 cm volume, solid- weighing 12 kg. On cutting, a multinoculated cystic cystic aspect, septa, hematic content, displacement of cavity containing clear mucoid aspect was observed. adjacent structures and moderate intra peritoneal free The postoperative period evolved uneventfully and liquid amount . CA 125 131.70 IU / ml, CEA 0.78 ng / the patient was discharged after the 3rd day of ml, Alpha-alpha-Protein 131.9 ng / ml. Cesarean section hospitalization. Discussion: The ovarian mucinous was performed with a midline 34-week GA incision with cystadenoma is a benign tumor and corresponds to a male newborn, WEIGHT: 1,900 gr, APGAR score: 8 - 80% of cases. It originates from the ovarian surface 9. Result from anatomopathological study of the left epithelium, with the possibility of reaching large annexectomy: 1,999 gr, EO 20 x 18 x 11c, with diagnosis dimensions. The differentiation between benign and of G2 endometroid adenocarcinoma, extensive areas of malignant varieties is made by tumor size, morphology, necrosis, ovarian-restricted neoplasia. It was decided presence of solid parts, papillary outgrowth, alteration to perform videolaparoscopic debulking 3 weeks after of echogenicity, ascites and metastases, and delivery, with negative pathology for neoplasia. Results: dopplervelocimetry staining. This information added to Malignant ovarian cancer cases in pregnancy are rarely the age of the patient and the histopathological nature reported. The therapeutic decision in this period is of the ovarian cyst is fundamental for therapeutic fundamental to guarantee the life of the fetus and the direction. Early diagnosis is difficult because they are survival of the mother who has the cancer disease, asymptomatic and when discovered present large having as options the termination of pregnancy, proportions. However, when symptomatic, the woman chemotherapy and/or cytoreductive surgery. In the complains of increased abdominal volume, severe pain,
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gastrointestinal, urinary and pelvic changes. In the similar to the present case, or with abdominal pain present case, the physical examination showed some due to tumor rupture or twisting or compression of signs that led to the suspicion of giant ovarian cyst. On nearby structures. In general, SBT is not invasive but palpation, it was painful, but a cystic mass was found, can spread through peritoneal implants, a factor that occupying the entire abdominal cavity. However, only negatively affects the survival of affected patients. by CT the diagnostic impression of a giant ovarian Final considerations:It is important to consider SBT cyst was confirmed. Final comments: The surgical as a differential diagnosis in unknown ovarian lesions, approach should always be by conventional approach, masses on pelvic tomography or even complaints of so that there is the exercise with adequate margins and constipation, given the expansive character of this type without rupture of the same. The reported study drew of tumor, also taking into account the possibility of attention for presenting an asymptomatic condition, invasive peritoneal infiltration, significantly worsening without the patient realizing its severity until the the prognosis of the patient. onset of the acute condition, due to its rapid growth, dimensions and weight reached and optimal prognosis Contato: Pedro de Albuquerque Mafaldo after the therapeutic approach. [email protected]
Contato: Jorge Antonio Álvarez Barrientos [email protected] TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 88023
TEMÁRIO: ONCOGINECOLOGIA IDIOPATHIC GRANULOMATOUS MASTITIS: CÓDIGO: 87850 CASE REPORT GIANT SEROUS BORDERLINE OVARIAN Autores: Wilson Garcia Pereira / Pereira, W.G. / UNEMAT; TUMOR: A CASE REPORT Fernanda Garcia de Carvalho Pereira / Pereira, F. G. C. / ; Oliver Guilherme da Silva / da Silva, O. G, / ; Luiza Autores: Pedro de Albuquerque Mafaldo / Mafaldo. Cupertino Bérgomi / Bérgomi, L. C.. P. A. / Universidade Potiguar; George Alexandre Lira / Lira. G. A. / Liga Norte Riograndense Contra o Câncer; Female pacient, 44 years old, G3P3, last delivery 18 Gustavo Torres Lopes Santos / Santos. G. T. L. / Liga years earlier, history of long-term breastfeeding, non- Norte Riograndense Contra o Câncer; Amanda Barbetto smoker, family history of breast cancer in a 45-years- Medeiros Torres / Torres. A.B.M. / Universidade old cousin. The patient presented persistent pain and Potiguar; André Luiz Costa e Silva / Silva. A.L.C. / volume increase in the left breast. Physical examination Universidade Federal do Rio Grande do Norte; Barbara showed a hardened area with undefined margins, a Paulo Cavalcante / Cavalcante. B.P. / Universidade diameter of 9 cm, occupying the upper-lateral quadrant Potiguar; Víctor José Negreiros de Sá Rosado / Rosado. of the left breast and a palpable axillary lymph node V.J.N.S. / Universidade Potiguar; Renata Beatriz Bessa without unusual appearance. Mammography revealed Teixeira / Teixeira. R.B.B. / Universidade Potiguar; an asymmetric area in the upper-lateral quadrant of Marina Fernandes / Fernandes. M. / Universidade left breast (BIRADS IVA). Ultrasonography revealed an Potiguar; Juliana Maria Caetano Nogueira / Nogueira. irregular tumor, with undefined margins (BIRADS IVA) J.M.C / Universidade Potiguar. measuring 2,4cm x 1,7cm. MRI of left breast showed an irregular tumor of 3,3 cm x 2,4 cm, with an extensive Case Presentation: M.L.S., a female, 69-years-old, area of hypercaptation adjacent to the nodule admitted complaining constipation for two weeks, in with 7 cm of extension and category IVC. The core association with increased abdominal volume and needle biopsy confirmed the diagnosis of idiopathic lower limb edema. She denied oncological antecedents. granulomatous mastitis. An extensive resection of the On examination, a globose abdomen with palpable lesion and local flap rotation for aesthetic repair of and movable mass, occupying the entire abdomen. the breast were performed with successful evolution. Abdominal computed tomography showed an The granulomatous mastitis is a rare, benign, chronic expansive cystic abdominopelvic lesion and thin internal inflammatory disease, whose etiology is unknown. septations of left ovarian origin with an estimated It occurs usually in young women with a history of volume of 9,300 cm³, which compresses and displaces recent lactation and it is associated with smoking and adjacent structures. CA 125 tumor marker of 264 U/ use of hormonal contraceptive. It can be presented ml. Two months later, it was performed an exploratory as an enlarging mass (57%), pain (33%), local laparotomy with a hysterectomy, and bilateral inflammation, lymph node enlargement and fistulas adnexectomy, frozen section procedure indicated cystic (15%). The diagnosis of idiopathic granulomatous lesion. Pathology revealed a 40 x 26cm borderline mastitis can only be established after excluding serous tumor without infiltration to other organs. secondary infections. The differential diagnosis with Currently, the case is free of disease and in outpatient breast cancer is imperative and determined only by follow-up. Discussion: The serous borderline tumor the histopathology as they have similar radiological (SBT) is characterized by atypical epithelial proliferation findings. On histology, granulomatous mastitis is of tubal epithelial cells without stromal invasion. characterized by noncaseating granulomas around Epidemiological data shows that they account for 10- breast lobes and often in association with microabscess 25% of serous ovarian tumors, and have an incidence and inflammatory process rich in histiocytes. The most of 55% of borderline tumors. Generally asymptomatic, commonly used therapy is the surgical excision of however, may occasionally present as a pelvic mass, the granuloma. Steroids have been shown to help in
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shrinking the lesion, reducing recurrence and post nodes by laparoscopy was 23,1 and, by laparotomy, operatory complications. Immunosuppressive drugs was 21,7. Conclusions: The 2 and 5-year survival of can achieve better control of inflammatory processes cervical cancer patients treated by LVRH were similar and prevention of future complications, persistence, to patients treated by RAH. The average of lymph nodes fistulas, abscesses, skin ulceration and recurrence (from by laparoscopy was greater than laparotomy, without 16 to 50%). The case described aims to remember the significant difference. main characteristics of the disease, the mandatory need for differential diagnosis with inflammatory carcinoma Contato: Suzana Arenhart Pessini and to review the presentation, diagnosis and correct [email protected] treatment of the disease.
Contato: Wilson Garcia Pereira TEMÁRIO: ONCOGINECOLOGIA [email protected] CÓDIGO: 87087
LEIOMIOSSARCOMA PRIMÁRIO DE VAGINA TEMÁRIO: ONCOGINECOLOGIA COM METÁSTASE EM OVÁRIO E RETO, RELATO CÓDIGO: 88186 DE CASO EM HOSPITAL DE REFERÊNCIA LAPAROSCOPIC-VAGINAL RADICAL HYS- ONCOLÓGICA NA AMAZÔNIA TERECTOMY: CAN BE A OPTION TO TREAT Autores: Rodrigo Luiz Ferreira Santos / RODRIGO L. PATIENTS WITH EARLY CERVICAL CANCER F. SANTOS / HOSPITAL OPHIR LOYOLA; Lorena L. M. WITHOUT COMPROMISING SURVIVAL? N. Fernandes Loureiro / Lorena L. M. N. Fernandes Loureiro / HOSPITAL OPHIR LOYOLA; Rodrigo Custódio Autores: Suzana Arenhart Pessini / Pessini, S.A. / R. Aguiar / Rodrigo Custódio R. Aguiar / HOSPITAL Universidade Federal do Rio Grande do Sul e Programa OPHIR LOYOLA; Victor F. Ferreira / Victor F. Ferreira / de Pós-Graduação em Ginecologia e Obstetrícia da HOSPITAL OPHIR LOYOLA; Fabio A. Morikawa Caldeira / UFRGS; Maria Cristina Barcellos Anselmi / Anselmi, Fabio A. Morikawa Caldeira / HOSPITAL OPHIR LOYOLA; M.C.B. / Irmandade Santa Casa de Misericórdia de Porto Breno Serique Neves / Breno Serique Neves / HOSPITAL Alegre; Geraldo Gastal Gomes-da-silveira / Gomes-da- OPHIR LOYOLA. Silveira, G.G. / Irmandade Santa Casa de Misericórdia de Porto Alegre e CliniOnco; Gustavo Py Gomes da Silveira Apresentação do caso A.T.S, 41 anos, sexo feminino, / Silveira, G.P.G. / Universidade Federal de Ciências da natural de Belém, Pará. Referenciada em Agosto/2018 Saúde de Porto Alegre. a serviço de oncoginecologia devido queixa de sangramento vaginal, e apresentando ao exame físico Introduction: Recent prospective randomized trial tumoração exofítica de grande volume em parede about surgery in cervical cancer results in worse vaginal à direita (D) com infiltração de colo uterino, survival with laparoscopic or robotic approach. Another apresentou biópsia com resultado anatomopatológico one, retrospective, demonstrate that combined evidenciando neoplasia maligna fusocelular, infiltrante, laparoscopic-vaginal approach is safe, with similar em mucosa vaginal, com painel imuno-histoquímico survival. Objectives: To determine 2 and 5-year survival concluindo tratar-se de leiomiossarcoma, neste in early cervical cancer patients treated by laparoscopic- momento os exames de estadiamento não evidenciaram vaginal radical hysterectomy (LVRH) and to compare doença em sítio não pélvico, foi encaminhada à with historical series by radical abdominal hysterectomy histerectomia, colpectomia e vulvectomia. No intra- (RAH). To determine the average of lymph nodes at the operatório foi observada linfonodomegalia em cadeias laparoscopic pelvic lymphadenectomy and to compare inguinais bilaterais e mesorreto, assim como implantes with the historical series by laparotomy. Design: em reto médio e baixo, e ovário esquerdo (E), foi Concurrent cohort study (group 1) and retrospective realizada vulvectomia parcial D, colpectomia parcial D, case control study (group 2). Patients and Methods: histerectomia total ampliada com salpingooforectomia Patients with cervical cancer FIGO stage Ia2 and Ib1 (< bilateral, linfadenectomia pélvica bilateral, retro- 2cm) submitted a LVRH, from 2001 to 2007 (group 1, peritoneal e colostomia em alça. Imuno-histoquímica da n=64), and submitted a RAH from 1995 to 2007 (group peça cirúrgica confirmou leiomiossarcoma metastático 2, n=108). The laparoscopic time consisted of pelvic em ovário E e reto (estádio IV), encaminhada então à lymphadenectomy, bipolar cauterization or placement quimioterapia. Ao reestadiamento pré-adjuvância, of clip and section of uterine artery, preparation of foram evidenciadas: lesão com atividade osteoblástica paravesical and pararectal space and salpingectomy. em S2, nódulos com realce heterogêneo em mm glúteo The vaginal time starts making vaginal cuff closed máximo bilateral, bíceps femoral D, semitendinoso by Chrobak forceps. The bladder pillar, ureter and D, vasto medial D, aumento de linfonodos inguinais lateral ligament of bladder are identified, paracolpos, bilaterais, sem formações expansivas na pelve. Segue rectovaginal ligaments and paracervix are dissected. em acompanhamento da oncologia clínica. Discussão: The lymph nodes were sent separeted, left and right Os tumores malignos primários de vagina são raros, sides. Age, tumor size, hystologic type, number of sendo responsáveis por 1 a 2% das neoplasias malignas lymph nodes, metastasis and complications were do trato genital feminino. O leiomiossarcoma pode registered. Results: The 2 and 5 years-survival in group ocorrer em qualquer tecido muscular liso, sendo 1 patients were 98 and 96,2%, and, in group 2, were mais comuns no estômago, intetino delgado, útero 89,8 and 84,3% (p=0,09 and 0,2). General 2 and 5 years- e retroperitôneo. O tratamento primário consiste na survival were 92,8 and 88,3%. The average of lymph excisão cirúrgica com margens adequadas. O sarcoma
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de vagina é uma neoplasia agressiva localmente e com called Meigs Syndrome that may develop with the disseminação hematogênica, e a baixa prevalência increase of that tumor marker and mimic malignant desse tumor dificulta o estabelecimento de um neoplasms. This syndrome defined as the presence of manejo e tratamento adequados. De fato, a literatura pleural effusion and/or ascitic fluid in association with a encontrada a esse respeito consiste principalmente benign ovarian tumor, most often fibroid or thecoma. It em alguns casos clínicos ou pequenas séries de casos displays complete regression after tumor removal. Final Comentários finais: O leiomiosssarcoma primário de considerations:Meigs Syndrome has a benign nature vagina é um tumor maligno raro, constando poucos and a good prognosis after curative surgical treatment. casos relatados na literatura, constitui importante Its diagnosis is challenging, CA 125 elevation, and the diagnóstico oncológico e necessita de estudos presence of ascites in Meigs syndrome mimic malignant multicêntricos para sua adequada caracterização ovarian neoplasms, and this condition should always be epidemiológica, assim como definição de seu perfil part of the differential diagnosis. biológico para correto manejo clínico-cirúrgico. Contato: Víctor José Negreiros de Sá Rosado Contato: Rodrigo Luiz Ferreira Santos [email protected] [email protected]
TEMÁRIO: ONCOGINECOLOGIA TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 88165 CÓDIGO: 87923 METASTASIS IN UTERUS, FALLOPIAN TUBE MEIGS SYNDROME BY OVARIAN FIBROMA: A AND OVARIES SECUNDARY A LOBULAR CASE REPORT BREAST CANCER: AN ASYMPTOMATIC Autores: Marina Fernandes / Fernandes, M. / Liga Norte PATIENTS FINDING - A CASE REPORT Riograndense Contra o Câncer; George Alexandre Autores: ágata Rothert / Rothert, A. / Hospital São Lira / Lira, G. A. / Liga Norte Riograndense Contra o Vicente; Fabio Roberto Fin / Fin, F. R. / Hospital São Câncer; Thiago Costa Pires / Pires, T. C. / Liga Norte Vicente; Priscila Nunes Silva Morosini / Morosini, P. N. Riograndense Contra o Câncer; Gustavo Torres Lopes S. / Hospital São Vicente; Nayara Greselle / Greselle, Santos / Santos, G. T. L. / Liga Norte Riograndense Contra N. / Hospital São Vicente; Marcela Santos Cavalcanti / o Câncer; André Luiz Costa e Silva / Silva, A. L. C. / Liga Cavalcanti, M. S. / Hospital São Vicente. Norte Riograndense Contra o Câncer; Barbara Paulo Cavalcante / Cavalcante, B. P. / Liga Norte Riograndense Presentation: female, 47 years, with a 3 years evolution Contra o Câncer; Amanda Barbetto Medeiros Torres node in left breast. History of smoking and systemic / Torres, A. B. M. / Liga Norte Riograndense Contra o lupus erythematosus, in use of chloroquine. Already Câncer; Renata Beatriz Bessa Teixeira / Teixeira, R. B. B. with kids and in climateric period. At clinical examination, / Liga Norte Riograndense Contra o Câncer; Víctor José presented with a palpable node of 5,5cm that infiltrates Negreiros de Sá Rosado / Rosado, V. J. N. S. / Liga Norte skin and had axilary limph nodes bilatrally. The core Riograndense Contra o Câncer; Pedro de Albuquerque biopsy revealed a breast cancer, lobular invasive, Mafaldo / Mafaldo, P. A / Liga Norte Riograndense luminal B (ER 100%, PR 95% and Ki-67 18%, HER 2 Contra o Câncer. negative). The bone scan showed multiple metastasis all over axial skeleton, and the valor of CA15-3 was 62,7. Case Presentation: A.S.C., female, 25-years-old, historic The pelvic ultrasound reavealled hypoechoic nodes of constipation, vomiting, hair loss, and menstrual in uterus, suggestive of myomas and endometrium irregularity about a year ago, when she noticed the thickening of 32mm, without vascularization on development of a pelvic mass. On abdominal palpation, doppler. No alterations was observed in fallopian tubes a large abdominal mass of approximately 25 x 25 cm. and ovaries. After local treatment of the breast, a total In pelvic MRI, the presence of a massive solid-cystic hysterectomy was performed. The histopathological expansive lesion with a slight enhancement of its solid evaluation showed an adenocarcinoma with signet component in the right hemipelvis, without cleavage ring cells in endometrial polyps, all uterine wall, both planes and forming a body with the left ovary, measuring fallopian tubes and both ovaries. These findings were 19.3 x 8.9 x 19, 2 cm, suspicious for neoplasia, and small compatible with lobular carcinoma secundary of the ascites. The patient had a CA 125 marker elevation of breast cancer. The test with GATA-3 was positive. 149 U/ml. During surgery was found moderate ascites Discussion: The common sites of metastasis of breast and a large tumor in the left annex. Performed left cancer are bones, lungs and liver. The literature says oophorectomy with complete excision of the lesion, and only 3,8 % of patients with metastasis have uterus, the frozen section procedure characterized benignity. fallopian tubes and ovaries affected. The most common The pathological examination revealed ovarian fibroma. histological kind is the lobular because of its hematic The patient discharged from the service. Discussion: spreading. About 60% of the patients with lobular The ovarian fibroma is a type of benign solid ovarian cancer have metastasis in the moment of diagnosis, stromal cell tumor diagnosed in young women only 5% and the GATA-3 is a good marker of this metastatic of the time. CA 125 elevation is usually observed in cases situations. Final comments: metastasis in the uterus, of malignancy, which makes a differential diagnosis fallopian tubes and ovaries in nongenital cancer is a with malignant tumors indispensable. The association rare situation. The clinical assessment and the pelvic of a benign tumor, such as the one presented, and ultrasound are the basis for the correct follow up of this ascites, allows the diagnosis of a rare clinical etiology patients. Especially when the patient uses tamoxifen,
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the pelvic evaluation is mandatory and the possibility of rapid diagnosis in similar cases for early treatment and secundary lesions must be evaluated. The prognosis of better prognosis for patients. this kind of patient remais uncertain. Contato: Stefanie Sophie Buuck Marques Contato: Ágata Rothert [email protected] [email protected]
TEMÁRIO: ONCOGINECOLOGIA TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 85676 CÓDIGO: 87322 MODERALLY DIFFERENTIATED OVARIAN METASTATIC OVARY DYSGOMAMINOMA IN TUMOR OF SERTOLI-LEYDIG CELLS: A CASE A PATIENT WITH SWYER‘S SYNDROME: CASE REPORT REPORT Autores: Gustavo Torres Lopes Santos / Santos, G.T.L. Autores: Stefanie Sophie Buuck Marques / MARQUES, / Liga Norte Riograndese contra o cancer - RN; George S.S.B. / FMABC; Fernanda Batistini Yamada / YAMADA, Alexandre Lira / Lira, G.A. / Liga Norte Riograndense F.B. / FMABC; Juliana Giangiardi Batista / BATISTA, J.G. / contra o câncer - RN; Daniella A Ramalho / Ramalho, FMABC; Rafael Martins Steffen / STEFFEN,R.M. / FMABC; D.A. / UNP - RN; Lourrane Cury B Medeiros / Medeiros, Gian Carlo Vassoler / VASSOLER, G.C. / FMABC; Isabela L.C.B. / UNP - RN; Joheberth F Moreira / Moreira, J.F. / Santas de Miranda / MIRANDA, I.S. / FMABC. UNP - RN; Gabriela Benneti de Grande Santos / Santos, G.B.G. / UNP - RN. A 15-year-old woman, asymptomatic, during the diagnostic investigation of late puberty, presents a Sertoli-Leydig Cell Tumor (TCSL), also known as radiological finding of abdominal mass of probable androblastoma, is part of a group of tumors called sex ovarian etiology. Several imaging exams (USG, CT, MRI) cord tumors, being a rare type of ovarian cancer. Sertoli- have shown massive retrouterine abdominopelvic Leydig cell tumors usually produce androgens and may solidocystic formation, probably of an ovarian develop signs of virilization in patients. They represent less nature with an estimated volume of about 1790 cm³. than 0.5% of primitive ovarian neoplasms and although A karyotype of the patient that showed 46 XY was they may appear at any age, they are more common in performed, concluding that the patient has Swyer young adults. In this report, we present a case of Sertoli- Syndrome. We opted for the surgical approach, in Leydig cell tumor in the ovary of a 66-year-old patient who which hysterectomy, bilateral salpingoophorectomy, was referred to the Luiz Antônio Hospital - LIGA Norte rio- peritoniectomy, associated with rectosigmoidectomy grandense Against Cancer- in Natal- RN for presenting an with primary anastomosis were performed. The ovarian lesion. in transvaginal ultrasound with volume of surgical procedure presented optimal cytoreduction. 230.4 cm3, which evolved significantly at 1 year and 11 Patient was discharged in the fifth postoperative day months, compared with transvaginal ultrasound of the without drains and on a light diet. During follow-up previous year that showed the same lesion with volume at the oncologic surgery outpatient clinic, the patient 2.0 cm3. The patient underwent exploratory laparotomy received pathology compatible with pT3c pN0 pM1 and total abdominal hysterectomy with bilateral salpingo- dysgerminoma. Her follow up is being done with clinical oophorectomy and complete surgical staging after oncology. Swyer Syndrome is caused by abnormal freezing. Adjuvant platinum based treatment. Follow up sexual differentiation during the embryonic period, resulting in incomplete intrauterine masculinization Contato: Gustavo Torres Lopes Santos and undifferentiated gonads. It is classified as complete [email protected] or pure gonadal dysgenesis, characterized by female phenotype and 46 XY karyotype (normal). It is a rare syndrome with an incidence of 1: 80000. Often normal TEMÁRIO: ONCOGINECOLOGIA height, normal axillary and pubic hair, presence of small CÓDIGO: 87264 or underdeveloped breasts, typical female external genitalia, upper vagina and normal or reduced size NEOADJUVANT PLATINIUM CONTAINING tubes and small or rudimentary uterus. The gonads CHEMOTHERAPY FOLLOWED BY SURGERY are usually composed only of fibrous tissue, have no hormonal function or gametogenesis. They often seek ON LOCALLY ADVANCED CERVICAL medical attention because of primary amenorrhea or ADENOCARCINOMA underdevelopment of sexual characters. The fonads Autores: Vinicius Cesar Furquim / Furquim, V.C / have a high risk of tumor development, being the Hospital Regional do Cancer de Passos; Maysa Lemos most common in patients with Swyer syndrome, Simosono / Simosono, M.L. / Hospital Regional do Disgerminomas, which have an incidence of up to 20- Cancer de Passos; Monique Godinho Rosa / Rosa, M. G 30% of cases. These tumors have a high potential for / Hospital Regional do Cancer de Passos; Luiz Gustavo malignancy. Approximately 65% of dysgerminomas are Hermógenes Pereira / Pereira, L.G.H / Hospital Regional at stage 1 at diagnosis, of which 90% are confined to do Cancer de Passos; Marcos Jose de Oliveira Junior / a single ovary and 10% bilaterally. The most common Oliveira Junior, M.J. / Hospital Regional do Cancer de symptom is abdominal pain (70-80%) and low abdominal Passos; Cleuber Barbosa de Oliveira / Oliveira, C.B. / mass, its treatment is surgical. The case reported, Hospital Regional do Cancer de Passos; Liliane Cristina although rare, brings to light the need for suspicion and da Silva / Silva, L.C. / Hospital Regional do Cancer de
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Passos; Nyandra Cardoso Theodozio / Theodozio, N.C. Santos / Santos, R. L. F. / Hospital Ophir Loyola; Lorena / Hospital Regional do Cancer de Passos; Marilia Maria L. M. N. F. Loureiro / Loureiro, L. L. M. N. F / Hospital Miguel / Miguel, M.M. / Hospital Regional do Cancer Ophir Loyola; Fábio A. Morikawa Caldeira / Caldeira, F. de Passos; Paulo Cesar Felipe Franco / Franco, P.C.F / A. M. / Hospital Ophir Loyola; Breno Serique Neves / Hospital Regional do Cancer de Passos. Neves, B. S. / Hospital Ophir Loyola; Amanda Raminho Luz / Luz, A. R. / Hospital Ophir Loyola; Victor F. Ferreira Case 1: 34 years old, with vaginal discharge and a 5cm / Ferreira, V. F. / Hospital Ophir Loyola. lesion in the cervix on gynecological examination; biopsy showing invasive Adenocarcinoma moderately Relato do caso: C.R.C.F. 44 anos, feminino, natural de differentiated (July/2018). Clinical staging was Belém/Pará, com história de dor em fossa ilíaca direita supplemented with pelvic and abdominal CT, defining há cerca de 01 ano, associada à perda ponderal de 08 a stage Ib2. The pacient was reffered to neoadjuvant kg neste período. Em dezembro de 2018 realizou USG chemotherapy (Carboplatin + Paclitaxel 3 cycles) and transvaginal evidenciando uma massa heterogênea posteriorly to surgery - Total abdominal Hysterectomy complexa de contornos e limites mal definidos medindo Piver 3 (Nov/2018). Confirmed invasive adenocarcinoma 9.6x9.4 cm em ovário direito com ca-125 (171,2 u/ml). at anatomopatolhogical exam, with 1,5cm extension and Paciente foi encaminhada ao serviço de referência em 0,3 cm depth, no vascular or perineural invasion, free oncologia, para avaliação, e ao exame físico, identificou-se surgical margins and Parametrium, besides 0/5 lymph massa em fossa ilíaca direita. Foi submetida à laparotomia nodes compromised (ypT1a1 ypN0 stage Ia1). Therapy exploradora onde evidenciou tumoração de apêndice completed with adjuvant chemotherapy + Radiotherapy cecal. Realizado apendicectomia e biópsia de mesentério. until March/2019. Case 2: 46 years old, sporadic vaginal O histopatológico evidenciou adenocarcinoma mucinoso bleeding and a 6cm cervix lesion; biopsy showed invasive da ponta de apêndice e biópsia de mesentério atestou Adenocarcinoma. Staged with physical examination + mucinose. Paciente encaminhada à oncologia clínica e Pelvic and Abdominal CT, defining a Ib2 stage (July/2018). seguindo acompanhamento até o momento. Discussão: Submmited to Neoadjuvant Chemotherapy (Carboplantin A neoplasia de apêndice cecal é uma variante rara do + Paclitaxel 3 cycles) and posteriorly to Total Abdominal câncer de cólon, sendo responsável por apenas 0,2 a Hysterectomy Piver 3 + bilateral Oophorectomy at 0,5 por cento de todos os tumores gastrointestinais. Nov/2018; the invasive Adenocarcinoma was confirmed, Dentre os diversos tipos histológicos existentes, o GII, 0,9cm depth and 1,5 extension, no vascular or adenocarcinoma mucinoso representa o tipo mais perineural invasion, Parametrium and surgical margins comum. Acomete o sexo masculino na proporção free, uterine attachments without invasion and 0/4 de 5:2 e incide principalmente entre a sexta e sétima lymph nodes compromised (ypT1b1 ypN0). Therapy was décadas de vida. Associado à sua raridade, a neoplasia supplemented with adjuvant Chemotherapy (Cisplastin) de apêndice possui clínica inespecífica, deixando o seu + Radiotherapy until March 2019. Discussion: The diagnóstico desafiador, manifestando-se geralmente Cervical Adenocarcinoma represents 10-20% of all como uma apendicite aguda, porém, a neoplasia pode cancer cases of this site, but its incidence has increased crescer insidiosamente até atingir grandes dimensões, in the recent decades. The prognoses is worse than the com invasão de estruturas adjacentes como bexiga, Squamous cells and, in the locally advanced cases, the ovários, cólon ou parede abdominal e simular tumor treatment is bases on Chemotherapy + Radiotherapy. primário de outro sítio. O tratamento de escolha é Good results are being achieved with Neoadjuvant cirúrgico. Pacientes submetidos a apendicectomia com Platinium-containing chemotherapy followed by surgery anatomopatológico compatível com adenocarcinoma (Total Abdominal Hysterectomy) for Ib2-IIa stages de apêndice podem ser seguidos sem complementação pacients with Squamous cells tumors, but few evidence com hemicolectomia, nos casos de lesões não invasivos, are available for Adenocarcinoma. In these both cases restritos a mucosa e que não atingem mesoapndice , young women with Ib2 stage had partial clinical and ou base do apêndice.Comentários finais: A neoplasia pathological response for neoadjuvant chemotherapy. de apêndice cecal é uma das variantes de câncer de Is said by some authors that this partial response cólon mais raras. Dentre os diversos tipos histológicos, impact on survival. Final considerations:Neoadjuvant o adenocarcinoma mucinoso é o mais comum, sendo chemotherapy with Carboplatin+Paclitaxel followed by prevalente em homens na sexta e sétima década de Total Abdominal Hysterectomy may be an option for vida. Seu diagnóstico geralmente é histológico, após pacients with locally advanced Cervical Adenocarcinoma. apendicectomia, que é o tratamento de escolha para os tumores não invasivos. Seu prognóstico vai depender do Contato: Nyandra Cardoso Theodozio grau de diferenciação da lesão e estadiamento. [email protected] Contato: Rodrigo Custódio Rodrigues de Aguiar [email protected] TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 87866 TEMÁRIO: ONCOGINECOLOGIA NEOPLASIA PRIMÁRIA DE APÊNDICE CECAL CÓDIGO: 87463 SIMULANDO NEOPLASIA ANEXIAL: RELATO OVARIAN GIANT MUCINOUS CYSTOADENOCARCINOMA: DE CASO EM HOSPITAL DE REFERÊNCIA CASE REPORT ONCOLÓGICA DA AMAZÔNIA Autores: Renata Bruna Garcia dos Santos Gatelli / Autores: Rodrigo Custódio Rodrigues de Aguiar / Aguiar, GATELLI, R.B. / Hospital de Clínicas de Passo Fundo R. C. R. / Hospital Ophir Loyola; Rodrigo Luís Ferreira
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; Charles Nilton Gatelli / GATELLI, C.N. / Hospital de Vieira Barros / Barros, A.V. / Santa Casa de Misericórdia Clínicas de Passo Fundo; Letícia Signori Kohl / KOHL, L.S. de Maceió; Claudemiro de Castro Meira Neto / Neto, / Universidade Federal da Fronteira Sul; Ana Paula Fauth C.C.M. / Santa Casa de Misericórdia de Maceió; Robério Seibel / SEIBEL, A.P. / Universidade de Passo Fundo; Silva Melo / Melo, R.S. / Santa Casa de Misericórdia de Gabriela Tatto Roggia / ROGGIA, G.T. / Universidade Maceió; Amanda Lira dos Santos Leite / Leite, A. L. S. de Passo Fundo; Karine Cadore Dariva / DARIVA, K.C. / / Santa Casa de Misericórdia de Maceió; Tainá Santos Universidade de Passo Fundo; Anderson Sgarbossa / Bezerra / Bezerra, T.S. / Santa Casa de Misericórdia de SGARBOSSA, A. / Universidade de Passo Fundo; Rodrigo Maceió; Thiago Yamamoto Amaral / Amaral, T.Y / Santa Fuzinatto Fiorentin / FIORENTIN, R.F. / Hospital de Casa de Misericórdia de Maceió; Gustavo Mendonça Clínicas de Passo Fundo; Icaro de Azevedo Alexandre / Ataíde / Ataíde, G M. / CESMAC; Igor Lima Buarque / ALEXANDRE, I. A. / Universidade Federal da Fronteira Sul. Buarque, I. L. / CESMAC; Alberson Maylson Ramos da Silva / Silva, A. M. R. / Santa Casa de Misericórdia de Case Presentation: A 52-year-old patient, hypertensive, Maceió. former smoker, menopausal for 5 years, reports lower abdominal pain for 1 month of greater intensity in FID. Introduction: Pelvic Exenteration in gynecological 7 months ago, he noticed abdominal mass growth, neoplasia constitutes a radical surgical procedure causing discomfort in the supine and lateral position. consisting of the removal of female reproductive organs, Reports weight loss and anorexia. Physical examination urinary tract and rectosigmoid. Most are performed for revealed a globose abdomen, with a massive mass of the treatment of cervical neoplasia, primary or recurrent, fibroelastic consistency and no collateral circulation. and less frequently in endometrium, vagina and vulva Specular gynecological examination without changes, tumors. It can also be used to treat complications without pain the uterine mobilization. CT showed a associated with radiotherapy (Rectite, cystitis or massive heterogeneous solid-cystic expansive lesion fistulas). An exception surgery for well-selected patients with apparent origin in the left pelvic region extending with disease restricted to the pelvis represents the only to the upper abdomen in mesogastric topography, existing curative treatment with a 5-year survival of 20 determining caudal displacement of the uterus and to 50%. Method: Retrospective analysis of the medical kidneys, as well as adjacent small bowel and colonic records of patients with gynecological neoplasms loops. Solid content, with septa and calcifications inside, submitted to pelvic exenteration between years 2016 measuring about 31x19x27 cm³ with heterogeneous and 2019. Clinical, surgical and histopathologic variables contrast impregnation. Patient with CA 19-9 at 3,971 U / were evaluated. Surgical complications were classified ml, CA 125 84,0U / ml, CEA 14.0 U / ml, underwent xipho- by the Clavien Dindo scale. Results: Ten patients were pubic laparotomy with enlarged total hysterectomy and selected with the mean age of 56.3 years. Regarding the appendages, removing 8.570g mass, retroperitoneal type of neoplasia, 6 patients had uterine cervix neoplasia lymphadenectomy and pelvic and ascites fluid cytology with histopathology of squamous cell carcinoma with negative result for neoplastic cells. Pathology (SCC), 3 with vagina neoplasia (SCC) and 1 of uterine confirmed diagnosis of left ovarian Mucinous Carcinoma. body (leiomyosarcoma). We performed 4 previous Discussion: Mucinous carcinoma is the histological exenterations (40%), 2 posterior (20%) and 4 Total type of 3-4% of primary ovarian cancers. It is more (40%). The option of reconstruction in the submitted to common in women aged 40-50 years. Giant mucinous total pelvic exenteration was urocolostomy. Regarding cystoadenocarcinomas are rare as most cases are margins, 8 surgeries (80%) Had R0 resection and 2 diagnosed early during the gynecological routine. Primary surgeries (20%), R1, of these, all progressed disease and ovarian mucinous carcinomas are 8-20 cm in size, cystic died. All patients presented some type of postoperative or solid, unilateral and confined to the ovary. Above 15 complication, 3 patients classified as Clavien Dindo I cm, they are considered giant cysts and in these cases (30%), 2 patients grade II (20%), 3 patients grade III (30%), require resection due to their compressive symptoms 1 patient grade IV (10%) and 1 Patient grade V (10%). The and potential risk of malignancy. Its management should mean survival rate was 19.3 months. Conclusion: Pelvic be done by laparotomy to avoid perforation and leakage Exenteration represented in this series a feasible of cystic fluid in the cavity. Final comments: Periodic therapeutic option, with a high rate of R0 resection and gynecological examination is of paramount importance with low complication rates for well-selected patients. in order to prevent the development of giant ovarian masses. Although they are mostly benign, the differential Contato: Diego Windson de Araujo Silvestre diagnosis of malignancy and possible is essential. [email protected]
Contato: Letícia Signori Kohl [email protected] TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 88272
TEMÁRIO: ONCOGINECOLOGIA PERITONEAL TUBERCULOSIS AS DIFFEREN- CÓDIGO: 88229 TIAL DIAGNOSIS OF PERITONEAL CARCINO- MATOSIS PELVIC EXENTERATIONS IN ADVANCED GYNECOLOGICAL NEOPLASIA: CASUISTIC OF Autores: Henrique Barbosa de Abreu / Abreu, H.B. / THE ONCOLOGICAL SURGERY SERVICE OF Universidade de Brasília; Gustavo Antonio de Paula Prado / Prado, G.A.P. / Universidade de Brasília; Bruno MACEIÓ Rosa de Souza / Souza, B.R. / Universidade de Brasília; Autores: Diego Windson de Araujo Silvestre / Silvestre, Bruno Gustavo dos Santos / Santos, B.G. / Universidade D. W. A. / Santa Casa de Misericórdia de Maceió; Aldo de Brasília; Henrique Serra de Mello Martins / Martins,
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H.S.M. / Universidade de Brasília; Felipe dos Santos L.S. / Universidade Federal da Fronteira Sul; Ana Rodrigues / Rodrigues, F.S. / Universidade de Brasília; Paula Fauth Seibel / SEIBEL, A. P. / Universidade de Amario Pires de Barros Junior / Barros-Junior, A.P. / Passo Fundo; Gabriela Tatto Roggia / ROGGIA, G.T. Universidade de Brasília; Viviane Rezende Oliveira / / Universidade de Passo Fundo; Bruna Schmitt Puhl / Oliveira, V.R. / Universidade de Brasília. PUHL, B.S. / Universidade de Passo Fundo; Laurenlisiê Brittes / BRITTES, L. / Universidade de Passo Fundo; Case Report: Female, 32 years old, previously healthy. Rodrigo Fuzinatto Fiorentin / FIORENTIN, R.F. / Hospital Seeked medical attention complaining of right upper de Clínicas de Passo Fundo. quadrant abdominal pain for 1 month associated with anorexia and dry cough. Were requested abdominal Case Presentation: A 68-year-old woman who ultrasound (US) and computed tomography (CT). underwent total hysterectomy 8 years ago for invasive Were visualized ovarian cysts, moderate ascites and cervical squamous cell carcinoma, free margins, without right pleural effusion. Referred to the cancer surgery lymphovascular infiltration, received no complementary service. In the diagnostic investigation a new CT showed follow-up. Referred to oncologist for vaginal bleeding massive ascites, diffuse thickening of the peritoneal and anemia, denies pelvic pain or symptoms of local leaflets, nodular lesions in the Glisson capsule, bilateral invasion, reports altered bowel habit, ECOG 1. Pelvic ovarian cysts and Omental Cake. A transvaginal USG magnetic resonance showed 3.7 x 3.5cm nodule in was performed, which visualized a complex solid-cystic contrast-impregnated vaginal dome, invasion of the image in the right ovary. Requested tumor markers: detrusor muscle layer near the sigmoid. Dome biopsy CA-125 1986 U / ml, CA 19.9 and CEA results within diagnoses recurrent squamous cell carcinoma. Staging normal range. After diagnostic investigation, proposed tomography shows right colon thickening. Colonoscopy cytoreductive surgery. Intraoperatively, peritoneum and shows low-grade tubular adenoma at the bottom of the abdominal organs were covered with multiple granular caecum, ulcer-green, 5cm, with invasion to the serosa, lesions and Sclerosing encapsulating peritonitis. Freezing moderate desmoplasia, perineural infiltration. Patient biopsy demonstrating chronic granulomatous process undergoes right ileocolectomy and adjuvant radiotherapy. with the presence of giant, multinucleated Langhans Discussion: After treatment of a neoplasm, patients are cell macrophages. Performed omentectomy due to at high risk of recurrence, in addition to a higher risk of areas of necrosis. Were realized peritoneal biopsy and secondary tumors as a result of chemo or radiotherapy ascites fluid culture. Specific staining was performed on treatment or associated genetic factors. Commonly, omentum samples and peritoneum biopsies for fungi recurrences of cervical cancer will occur within the first and Mycobacterium, both negatives. Peritoneum sample 2 to 3 years after initial treatment. They usually present culture without growth. The anatomopathological symptomatically, including pelvic or lower limb pain, result concluded that it was tuberculoid granulomatous lymphedema, bleeding or vaginal discharge, urinary peritonitis. Further diagnostic investigation for symptoms and weight loss. Colorectal carcinoma is tuberculosis (TB) showed only adenosine deaminase one of the most common neoplasms in the world adult (ADA) in positive ascitic fluid, all other tests were negative population, being the fourth most malignant tumor. (05 sputum samples with AFB and ascites fluid culture). frequent in women. The incidence of tumors in the right RIPE started on the 5th postoperative day. Patient had colon is increasing, which commonly present with anemia, complete remission of ascites and symptomatology. fecal occult blood, abdominal discomfort and / or palpable Discussion: The present case retracts the difficulty of abdominal mass. This suggests that the concomitance making a differential diagnosis between carcinomatosis of the patients right colon tumor is due to the high and peritoneal tuberculosis. Imaging and tumor markers prevalence of the tumor in the general population. Final (CA-125) corroborated the diagnosis of peritoneal comments: Due to the lack of adjuvant treatment in carcinomatosis of probable ovarian origin. Sclerosing primary uterine carcinoma, there is no treatment-related encapsulating peritonitis is rarely seen in peritoneal TB, factor associated with tumors, suggesting that uterine there are less than 100 cases reported in the literature, tumor recurrence and primary colonic cancer would have which makes its diagnosis difficult. Conclusion: arisen independently due to the high risk of recurrence. Peritoneal tuberculosis should be part of the differential high prevalence in its population. Thus, the importance diagnosis of peritoneal diseases, especially peritoneal of follow-up after surgical treatment of neoplasms, in carcinomatosis. order to verify recurrences, and population screening for colorectal cancer is important. Contato: Henrique Barbosa de Abreu [email protected] Contato: Letícia Signori Kohl [email protected]
TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 87452 TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 88024 RECURRENCE OF CERVICAL INVASIVE CARCINOMA ASSOCIATED WITH PRIMARY SQUAMOUS CARCINOMA CERVIC-VAGINAL RIGHT COLON CARCINOMA: A CASE REPORT RELATED IN A CHASTE, 90 YEARS OLD WOMAN SURGICALLY RESCUED WITH A Autores: Renata Bruna Garcia dos Santos Gatelli / GATELLI, R.G. / Hospital de Clínicas de Passo Fundo; PELVIC EXENTERANTION Charles Nilton Gatelli / GATELLI, C.N. / Hospital de Autores: Paulo Henrique Ribeiro de Oliveira / Clínicas de Passo Fundo; Letícia Signori Kohl / KOHL, Oliveira,P.H.R. / Hospital Escola Álavo Alvim; Pedro
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Augusto Corrêa de Araújo Rodrigues Caldas / Santos Gatelli / GATELLI, R.B. / Hospital de Clínicas de Passo Caldas,P.A.C.A.R. / Hospital Escola Álvaro Alvim; Paola de Fundo; Charles Nilton Gatelli / GATELLI, C.N. / Hospital de Araujo Sardenberg Alves / Alves,P.A.S. / Hospital Escola Clínicas de Passo Fundo; Letícia Signori Kohl / KOHL, L.S. Álvaro Alvim; Livia Nunes Barboza Duarte / Duarte,L.N.B. / Universidade Federal da Fronteira Sul; Gabriela Tatto / Hospital Escola Álvaro Alvim; Pedro Augusto Corrêa de Roggia / ROGGIA,G.T. / Universidade de Passo Fundo; Araújo Rodrigues Caldas / Caldas,P.A.C.A.R. / Hospital Eduardo Scharnovski / SCHARNOVSKI, E. / Universidade Escola Álvaro Alvim; Paola de Araujo Sardenberg Alves de Passo Fundo; Bernardo Cenci Basso / BASSO, B.C. / / Alves,P.A.S / Hospital Escola Álvaro Alvim; Pedro Universidade de Passo Fundo; Camilla Carmem Teixeira / Henrique Ferraro da Silveira / Silveira, P.H.F. / Hospital TEIXEIRA, C.C. / Universidade Federal da Fronteira Sul. Escola Álvaro Alvim; Luiza Demian Ribeiro Barbosa / Barbosa,L.D.R. / Hospital Escola Álvaro Alvim; Maria Case Presentation: A 48-year-old patient with a previous Teresa Fernandes Pessanha / Pessanha,M.T.F. / Hospital history of rectal cancer for sixteen years treated with Escola Álvaro Alvim; Haroldo José Siqueira da Igreja rectosigmoidectomy and adjuvant chemotherapy and Junior / Junior,H.J.S.I. / Hospital Escola Álvaro Alvim. radiotherapy. Twelve years later, abnormal uterine bleeding underwent subtotal hysterectomy. In the histological Apresentação do caso: Paciente do sexo feminino, 90 analysis moderately differentiated adenocarcinoma, the anos, branca, solteira. Menarca aos 13 anos, menopausa pattern being consistent with primary rectal neoplasia. aos 49 anos, G0P0A0. Nega uso de anticoncepcional oral Exposed to new cycle of chemotherapy. One year ago, e reposição hormonal. Nega ter tido relações sexuais. NIC2 trachelectomy with a negative control sac fundus Refere prurido vulvar de inicio há quatro meses, disúria, cytopathology for malignant cells. Genetic screening corrimento vaginal seroso de odor fétido, dor uretral e for Lynch syndrome with no criteria. The period after hematúria macroscópica, sem melhora com Nistatina e completion of chemotherapy with follow-up colonoscopy Fluconazol tópico. Ao exame ginecológico presença de and tomographic investigation was uneventful and membrana integra no respectivo limite do ducto vaginal e indicated no evidence of recurrence. Recently, she arrived da vulva(hímem presente ao exame), com lesão vegetante, at the Surgical Cancerology department with a vulval exofítica, de odor fétido, lesão crostosa com extensão vestibular mass with recent vaginal extension, friable para introito vaginal. Anatomopatológico evidenciando and with bleeding of approximately 5cm and irregular carcinoma epidermóide moderadamente diferenciado. appearance. The rectovaginal examination had no Ressonância nuclear magnética de abdômen e pelve: noticeable changes and there were no palpable inguinal Lesão expansiva e infiltrativa comprometendo o introito lymph nodes. The patient underwent a biopsy which vaginal com extensão para subcutâneo da gordura concluded adenocarcinoma with foci of necrosis and ísquio-anal, infiltrando por contiguidade o óstio uretral was compatible with the primary tumor site. Discussion: externo, medindo 2,6 x 2,5 x 1,4 cm. Estadiamento clínico Primary vulvar cancer is uncommon, accounting for only cT3cN0cM0(EC III). Tratamento inicial com radioterapia 3-5% of all gynecological cancers and <1% of all cancers definitiva isolada 50GY / 28 frações. Em acompanhamento in women. Metastatic tumors of the vulva are even more ambulatorial paciente apresentou volumosa lesão tumoral uncommon, accounting for only 5 to 8% of all vulvar vulvo/vaginal exofítica de maior dimensão em topografia cancers. When metastatic lesions are of extragenital de introito vaginal e com extenso acometimento local e origin, the gastrointestinal system is most commonly sem evidencia de metástase. Paciente selecionada para affected. Colorectal cancer is one of the most common resgate cirúrgico com exenteração pélvica. Discussão: types of cancer in western countries, with the most O carcinoma epidermoide localmente avançado vulvo/ frequent sites of metastatic involvement being the liver vaginal (EC III) tem o tratamento individualizado, podendo and lungs. More rarely, the disease spreads to the brain or incluir radioterapia, quimioterapia, cirurgia e até a bones. On the other hand, genital tract involvement is an combinação destas modalidades. A exenteração pélvica extremely rare event and, if it occurs, the ovaries are most é o tratamento cirúrgico radical para neoplasias pélvicas often affected followed by vaginal involvement. Final malignas recidivadas ou quando há persistência de considerations:There is no proposed standard diagnosis tumor na pelve após tratamento radioquimioterápico, and therapeutic methods for colorectal metastatic vulvar pode ser também o tratamento de escolha para câncer carcinoma. Due to the rare frequency of this disease, it ginecológico localmente avançado, consiste na ressecção is difficult to conduct large-scale laboratory experiments de todos os órgãos acometidos pelo câncer, com margens and prospective controlled clinical studies to clarify livres de doença. Comentários finais: A exenteração this disease. However, biopsy of all suspected lesions pélvica é uma opção terapêutica no carcinoma vulvo/ is important and tumor metastasis should always be a vaginal localmente avançado recidivado não passível de differential diagnosis. radioterapia adicional. Contato: Letícia Signori Kohl Contato: Paulo Henrique Ribeiro de Oliveira [email protected] [email protected]
TEMÁRIO: ONCOGINECOLOGIA TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 87782 CÓDIGO: 87491 TUMOR OVARIANO DE CÉLULAS DE LEYDIG STRAIGHT CANCER VULA METASTASES: CASE VIRILIZANTE EM PACIENTE PÓS-MENOPAUSA: REPORT RELATO DE CASO Autores: Fernanda Paula Schafer / SCHAFER, F.P. / Autores: Samantha Lzbg Soares / Soares, S. L. Z. B. G. Universidade de Passo Fundo; Renata Bruna Garcia dos / Universidade de Caxias do Sul (UCS); Aline Caldart
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Tregnago / Tregnago, A. C. / CPM Laboratório; Fernando Bruna Rabaioli / Rabaioli, B. / UNICRUZ - Cruz Alta - RS; de Marco dos Santos / Santos, F. M. / Hospital Geral de Graciele Meriane Machado / Machado, G.M. / UNICRUZ Caxias do Sul (HGCS); Rafael Fontana / Fontana, R. / - Cruz Alta - RS. Universidade de Caxias do Sul (UCS). Introduction: After the histological diagnosis of cervical Ovarian leydig cell tumor in a postmenopausal patient cancer, staging is necessary to determine the extent of with virilization Case Report: A 61 years old woman the disease and to define the conduct and the prognosis. presents with hirsutism, alopecia, voice thickening and The classification developed by the International clitoromegaly for 2 years. She is obese, hypertensive, Federation of Gynecology and Obstetrics (FIGO) is non-smoker, and denies use of androgenic drugs. widely used to stage cervical cancer. Objective: To Menarche at 13 years old and menopause at 50 years present the main updates in FIGO regarding the staging old. On physical examination, excess body hair on the of cervical neoplasia. Methods: Review of two articles lower abdomen was noted and she referred pain on published by FIGO. Results: The staging according to deep palpation on the left iliac fossa. Ultrasonography FIGO 2009 was based mainly on clinical examination and revealed a solid image with peripheral vascularization certain types of procedures such as cervical conization, in the left ovary. Laboratory tests showed high cystoscopy, and proctoscopy. In 2018, the following testosterone levels (431ng/dL). DHEA (2.7ng/mL), SDHEA modifications were made: (i) inclusion of imaging exams (93mg/dL), TSH (2.66mU/L), T4 (0.95ng/dL) were normal. such as computed tomography, magnetic resonance, A left oophorectomy was performed. Gross section and positron emission tomography; (ii) exclusion of the showed a 1.8 cm nodule. Histologic diagnosis was well- horizontal extent of the lesion, keeping only the tumor differentiated Leydig cells tumor without heterologous invasion depth to define the stage of microscopic lesions elements. Immunostains for Inhibin Alpha, Melan A, (stage IA); (iii) inclusion of subdivision IB3, based on the and Calretinin were positive, confirming the diagnosis. maximum tumor diameter, to stage IB; and (iv) inclusion Two months after surgery symptoms regressed, and of pelvic and retroperitoneal lymph node metastases to testosterone level decreased to 26ng/dL. Discussion: stage III. Conclusion: The incorporation of sophisticated Leydig cell tumors originate from gonadal stromal imaging exams is important in assessing the local extent cells. They are rare and represents less than 0.5% of all of the disease and lymphatic spread. The horizontal ovarian neoplasms. Leydig cells are androgen producing dimension of the tumor is no longer considered since it and causes virilization symptoms (present in 50% of is subject to artifact errors. The new subdivision of stage cases). Most are unilateral and restricted to the ovary, IB was necessary because there was an important gap being more frequent before 40 years old. Differential of tumor sizes with different prognoses between the diagnosis is more challenging in postmenopausal stages IB1 and IB2. Finally, lymph node dissemination is women because hormonal changes and ovarian a significant prognostic factor in the survival of cervical neoplasms are frequent in this age. Elevated serum cancer patients. testosterone raises the suspicion and normal levels of SDHEA and DHEA rule out adrenal neoplasms. Patients Contato: Lucas Adalberto Geraldi Zanini without hyperandrogenic symptoms may have pain [email protected] and increased waist circumference which are often late symptoms of more advanced stages. Prognosis depends on stage, degree of differentiation and presence of TEMÁRIO: ONCOGINECOLOGIA heterologous elements. Well differentiates tumors are CÓDIGO: 87618 benign, treated with open or laparoscopic surgery. Bilateral salpingophorectomy is indicated when there is UTERINE ADENOSARCOMA: CASE REPORT no need to preserve fertility. Symptoms regresses after surgical treatment. Adjuvant chemotherapy is indicated Autores: Lavínia Barcellos Araújo / Araújo, L.B. / only in patients with unfavorable prognostic factors. Faculdade de Ciências Médicas e da Saúde de Juiz de Conclusion: Leydig cell tumors are rare, especially in Fora - SUPREMA; Eliel Oliveira de Araújo / Araújo, E.O. post-menopausal women. Surgical treatment leads to / Solus Oncologia; Bruno Couto Gonçalves / Gonçalves, symptom regression. Pathological features impact on B.C. / Faculdade de Ciências Médicas e da Saúde de Juiz prognosis and allow differential diagnosis with other de Fora - SUPREMA; Larissa Soares Cardoso / Cardoso, ovarian neoplasms. L.S. / Universidade Federal de Roraima; Allyce Filgueiras Netto / Netto, A.F. / Faculdade de Ciências Médicas e da Contato: Fernando de Marco dos Santos Saúde de Juiz de Fora - SUPREMA; Felícia Barcelos de [email protected] Almeida / Almeida, F.B. / Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA; Amanda Leite Sousa / Sousa, A.L. / Faculdade de Ciências Médicas e TEMÁRIO: ONCOGINECOLOGIA da Saúde de Juiz de Fora - SUPREMA. CÓDIGO: 88350 Case Report: M.D.M.B., 71 years old, female. She has UPDATES IN CERVICAL CANCER STAGING had a case of metrorrhagia for three years, which was aggravated in May 2018 and is being investigated. Autores: Lucas Adalberto Geraldi Zanini / Zanini, Magnetic resonance imaging revealed an expansive L.A.G / CACON - IJUÍ - RS ; Gustavo Andreazza Laporte lesion in the lower uterine third and indicated / Laporte, G.A. / Santa Casa de Misericórdia de Porto hysterectomy and bilateral annexectomy, showing Alegre - RS; Rosilene Jara Reis / Reis, R.J. / Santa Casa fibroepithelial polypoid lesion without invasion of de Misericórdia de Porto Alegre - RS; Janice de Fátima the myometrium, ovaries and fallopian tubes. After Pavan Zanella / Zanella, J.F.P. / UNICRUZ - Cruz Alta - RS; surgical procedure, immunohistochemistry (IHC)
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revealed uterine adenosarcoma (UA). Smoking 2019 she underwent a diagnostic laparascopy in which patient, three previous pelvic surgeries, myocardial was visualized a exophytic, multilobulated, uterine infarction, myocardial revascularization, angioplasty, mass adhered to the lef pelvic peritoneum. Block mass hypothyroidism, arterial hypertension, diabetes mellitus resection was performed without perforation and the and arthrosis. Use of insulin, metformin, empaglifozine, histopathological diagnosis was biphasic neoplasia carvedilol, isosorbide mononitrate, clopidogrel, with benign stromal component and low malignancy pantoprazole and levothyroxine. Menarche at 13 years mesenchymal component, with immunohistochemistry old, menopause at 57 years old, G4P4A0. Denies family compatible with Mullerian Adenosarcoma, without neoplastic history and hormone replacement therapy. super stromal invasion and a mitotic index of 1/10 Returns 11 months after surgery, computed tomography fields. Discussion: Mullerian adenosarcoma is a (CT) reveals nonspecific pulmonary nodule, isolated rare mixed tumor that combines benign glandular alteration in the midst of good general condition and epithelium and low-grade sarcoma, with low grade absence of complaints, choosing follow-up and return malignancy. Uterine adenosarcomas represent 5.5 to after 4 months with chest, abdomen and pelvis CT, 9% of uterine sarcomas, about 1% of female genital mammography and laboratory tests. Discussion: UA is tract neoplasms and in most cases are asymptomatic. a rare malignant neoplasm, corresponding to only 0.2% In our hospital, 15 patients were diagnosed with of uterine cancers and has incidence in the ninth and uterine adenosarcoma between 2008 and 2019, seventh decades of life. It presents as a polypoid mass only 06 having Mullerian adenosarcoma. The most with the possibility of bleeding. About 98% of the cases common site of involvement is the body of the uterus have unilateral involvement, however the IHC revealed but may also occur in the cervix, ovaries, fallopian bilateral pattern, predominant malignant mesenchymal tubes and vagina. Those of the uterine body are more component and positive desmin mitotic figures. common in postmenopausal women, while the cervical Although there are no specific markers, morphological ones, in reproductive age women. The origin of the patterns usually affirm diagnosis. Such findings make adenosarcoma is not well defined and may correspond the case even rarer and with poorer prognosis and to multipotential stem cell or endometriosis foci. Factors survival, however the absence of myometrial invasion of poor prognosis include stromal overgrowth, high fits in stage IA. Adjuvant radiotherapy was not used, mitotic index and presence of heterologous elements, as are most cases that follow with hysterectomy and necrosis or extrauterine involvement. The standardized bilateral adnexectomy. Appendectomy is justified by approach is total hysterectomy with bilateral salpingo- the higher mortality associated with dissemination to phorectomy, but it is a difficult decision on young ovaries and fallopian tubes. Expression of estrogen or women wishing to preserve fertility. Final comments: progesterone receptors in UA may relate to neoplastic Mullerian adenosarcoma remains a rare tumor, with no advancement, and ovarian resection reduces hormone well-established origin, uncertain behavior and yet no levels, although it has not been proven as a risk factor. standardized management. Final comments: This is a rare case of malignant neoplasia with atypical repercussion due to the Contato: Michelle Louise Rodrigues Barbosa da Silva pattern of involvement. Management was carried out [email protected] appropriately, following evidence. Patient remains stable and in follow-up. TEMÁRIO: ONCOGINECOLOGIA Contato: Lavínia Barcellos Araújo CÓDIGO: 87124 [email protected] UTERINE CERVICAL NEOPLASM WITH CENTRAL NERVOUS SYSTEM METASTASIS: TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 87099 REPORT OF TWO CASES Autores: Giovani Schulte Farina / Farina, G. S. / UTERINE BODY MULLERIAN ADENOSARCOMA Universidade de Caxias do Sul (UCS); Carolina Matté IN PREMENOPAUSE PACIENT - CASE REPORT Dagostini / Dagostini, C. M. / Universidade de Caxias do Sul (UCS); Aline Caldart Tregnago / Tregnago, A. C. / CPM Autores: Michelle Louise Rodrigues Barbosa da Silva Laboratório; Fernando de Marco dos Santos / Santos, / Silva, M.L.R.B / AC. Camargo Cancer Center; Levon F. M. / Hospital Geral de Caxias do Sul (HGCS); Rafael Badiglian-filho / Badiglian-Filho, L. / AC. Camargo Cancer Fontana / Fontana, R. / Universidade de Caxias do Sul Center; Glauco Baiocchi / Baiocchi, G. / AC. Camargo (UCS). Cancer Center. Case Presentation: Case 1: 49-year-old female patient Case Presentation: 38 years old pacient, no with history of cervical squamous cell carcinoma with comorbidities, childless, trying to get pregnant for involvement of parametrium, pelvic lymph node and 5 years, was submited to a transvaginal ultrasound paraortic chain (stage IVB) 6 months ago, underwent where was visualized a 10cm parauterine mass. She cisplatin chemoradiotherapy (PDD) and complementary didnt present any sintoms, besides the infertility. teletherapy, with temporospatial disorientation and Staging exams were performed, including magnectic slowing of thought for a week. Magnetic resonance resonance of the pelvis which showed ovaries and imaging showed subcortical expansive lesion in the left uterus with no alteration and a solid, multilobulated, 10 frontal lobe, compatible with metastasis. Total resection cm parauterine mass. The were no pulmonar or liver of the lesion were performed. Pathological examination metastasis and she had a Ca-125 level of 71. In june and immunohistochemical panel compatible with
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squamous cell carcinoma metastasis. The patient had cell tumor (PEComa). The cellular proliferation index a good postoperative evolution. Case 2: A 64-year-old (Ki-67) was less than 1% and there werent found any female pa-tient with a 7 months ago history of uterine sign of necrosis and atypia. After clinical evaluation and cervical adenocarcinoma with parametrial and lower presence of expansive mass with the size of 13x3x9cm third of the vagina involvement (stage IIIB), underwent in pelvic TC, the patient was submitted to laparotomy PDD chemoradiotherapy. Hospital admission for in 05/2019. The tumor was unresectable, occupying right upper limb paresis and occipital headache. all the left part of pelvis, invading bladder and sigmoid Cranioencephalic magnetic resonance imaging showed colon. The biopsy confirmed retroperitoneal PEComa multiple nodular lesions with contrast-enhanced with focus of supurative acute inflammation and annular contrast, compatible with metastasis. absence of ominous morphologic signals. Discussion: Radiotherapy of the central nervous system (CNS) was The PEComas are rare mesenchymal tumors composed indicated and opted not to institute invasive measures. by perivascular epithelioid cells with immunoreactivity Patient evolved with mental confusion, seizures and for melanocytic or/and smooth muscle markers, in this lowering of the sensory by cerebral edema resulting patients case both were positive. These tumors can from radiotherapy treatment. Radiotherapy were mimetize others neoplasms as leiomyossarcomas and ceased in spite of the patients terminality. After 22 leiomyomas, that were important differential diagnosis days of admission, the patient developed bradycardia, in this patient. The literature reports about 100 cases drowsiness and death due to cardiopulmonary arrest. of PEComas, and 1/3 had origin in the uterus. These Discussion: Cervical cancer is the most common tumors show variable prognosis, and, accord of the gynecological cancer, being the fifth most prevalent classification of gynecological PEComas, the patients cancer in women and the fourth with the highest neoplasm presented criteria for malignancy (size > 5cm mortality. The main histological subtypes are squamous and infiltrative growing pattern).The chosen treatment cell carcinoma (90%) and adeno-carcinoma (10%). is surgical, as the adopted in this case, and the use of Metastasis of cervical cancer in the CNS are uncommon chemotherapy and radiotherapy in high-risk tumors, (0.3-2%), and it is even rarer to occur exclusively in this even with few randomized trials. Final comments: The topography. The average survival of these patients uterine PEComa is a rare pathology and the prognosis is estimated to be 12.75 months. When surgery and is extremely variable. The presented case, as a high- radiotherapy are performed, the average survival risk tumor, advocates a careful state of vigilance and increases to 22 months. There are less than 100 cases following-up on behalf of scarcity of information about in the literature describing exclusively metastasis in the that neoplasm and the variability of possible evolutions CNS. Treatment requires multidisciplinary approach. to the tumor. Final comments: In this case report we highlight the low frequency of CNS metastatic involvement in Contato: Marcos Antônio Lima Carvalho cervical cancer and its different outcomes. There are [email protected] less than 100 cases in the literature describing exclusive metastatic CNS involvement. TEMÁRIO: ONCOGINECOLOGIA Contato: Giovani Schulte Farina CÓDIGO: 87323 [email protected] VULVA MICROINVASIVE PAGET‘S DISEASE, A CASE REPORT AND LITERATURE REVIEW TEMÁRIO: ONCOGINECOLOGIA CÓDIGO: 87736 Autores: Bruno Rosa de Souza / Souza, B. R. / UnB/ HUB; Viviane Rezende de Oliveira / Oliveira, V. R. / UTERINE PECOMA WITH CRITERIA FOR HUB; Ceres Nunes de Resende / Resende. C. N. / HUB; MALIGNANCY: CASE REPORT Amário Pires de Barros Júnior / Barros Júnior, A. P. / HUB; Henrique Barbosa de Abreu / Abreu H. B. / UnB/ Autores: Marcos Antônio Lima Carvalho / Carvalho, HUB; Gustavo Antônio de Paula Prado / Prado, G. A. P. M. A. L. / Universidade Federal de Sergipe; João / UnB/HUB; Bruno Gustavo dos Santos / Santos, B. G. / Eduardo Andrade Tavares de Aguiar / Aguiar, J. E. A. UnB/HUB; Henrique Serra de Mello Martins / Martins, H T. / Universidade Federal de Sergipe; Roberto Queiroz S. M. / UnB/HUB; Thiago Almeida Hurtado / Hurtado, T. Gurgel / Gurgel, R. Q. / Fundação Beneficência Hospital A. / UniCEUB; Lucas Ernesto Do Rego Castro / Castro, L. do Cirurgia. E. R. / UniCEUB.
Presentation: Woman, 44 years, submitted to a A 53-year-old female patient which had a history hysterectomy with adnexectomy in 04/2018 for treatment of previous vulvar disease with long-term pruritus of uterine myomatosis. Previously to surgery, she had presented to the health service in September 2018. A a clinical condition of hypermenorrhea/menorrhagia. physical examination indicated an area of hypochromia The anatomopathological report of the uterus with thickening of the skin on the left small lip, a tumor showed intramural leiomyomas and a fusocellular/ in the clitoris region and hypochromic area with 2X2 cm epithelioid tumor amid collagenous stroma, measuring thickening on the large left lip, with no ulceration in the 24x22x7cm, affecting uterus and uterine appendages. described lesions. Biopsy was performed on the clitoris The immunohistochemistry showed coexpression of lesion with histopathological diagnosis of Extramammary muscular (desmin and actin) and melanocytic (HMB- Paget‘s disease with presence of microinvasion. 45) markers, indicating the myelomelanocytic origin of Preoperative exams were performed in September the tumor and the diagnosis of perivascular epithelioid and October 2018: transvaginal ultrasonography,
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mammography, breast ultrasonography, bone studies on melanoma, as well as to demonstrate the scintigraphy and pelvic magnetic resonance. Uterine epidemiological profile of the disease in the state of myomatosis was found without inguinal or pelvic Mato Grosso. Method: Retrospective analysis of 2,228 lymph node enlargement on the MR. Mammography hospitalizations due to melanoma. Information was was categorised as Bi-Rads 2. In October 2018, she obtained from the DwWeb inpatient notification system underwent a hemivulvectomy with clitoral amputation from 2000 to 2018. During data analysis, 1,472 patients and sentinel lymph node biopsy with neoplasia-free were excluded from the study due to inconsistent skin margins. The biopsy confirmed a Multifocal Paget‘s color data, leaving 756 for the analyzes. Results: The Disease on Histopathology and immunohistochemistry total percentage of patients with the disease in the state with two macroscopic foci and two microscopic foci. was higher in non-white individuals, with 64.29% (N = There were no postoperative complications. Paget‘s 486), when compared to white individuals. Males were disease can be classified into two groups: mammary the most affected 50.4% (N = 381), and mortality in non- and extramammary. The extramammary form consists white men was 3.50%, twice as high as in white men of a rare group of cutaneous neoplasia, with several (1.48%). Overall mortality for both sexes was 2.78%. sites, usually found in areas with high density of Regarding the affected body regions, 88.89% presented apocrine glands, such as vulva, anus, perianal region the neoplasm in sun-exposed areas, the face being and axilla. The clinical presentation has nonspecific more frequent in this study. According to bivariate symptoms, being the most frequent long-term analysis, there was no significant difference between pruritus. On physical examination, the main finding the involvement of exposed areas and skin color (p = is macroscopically eczematous, erythematous, scaly 0.15). As well as, there were no significant differences lesions, with poorly defined edges and the presence of between skin color and the following characteristics: white streaks, usually located in the vulvar regions with gender (p = 0.22) and death (p = 0.1). Conclusion: hair. The diagnosis is made through deep biopsy of the Undoubtedly, the correct data collection is essential lesion. It has surgical treatment and may be performed for epidemiological studies on the subject. However, with extended excision or vulvectomy, inguinal by correlating the existing data, we concluded that in lymphadenectomy should be performed in cases our state the highest rates of melanoma occur in the of underlying vulvar adenocarcinoma. Paget vulvar non-white population, in males, and the most affected disease is an extremely rare condition, accounting for skin region is the face. Among the mortality analyzes, about 1% to 5% of vulvar neoplasia. Due to its rarity, the a greater relationship was found with non-whites and most appropriate treatment is not yet well established. trunk involvement. In view of this, the present case is relevant to inform the medical community about this pathology and Contato: Natália Santana Moreira Nunes contribute to a better understanding of it. [email protected]
Contato: Bruno Rosa de Souza [email protected] TEMÁRIO: ONCOLOGIA CUTÂNEA CÓDIGO: 87606
TEMÁRIO: ONCOLOGIA CUTÂNEA ANALYSIS OF PATIENTS SUBMITTED TO CÓDIGO: 87157 SENTINELY LYMPHONODUS RESEARCH AT A REFERENCE PUBLIC HOSPITAL IN THE PERIOD ANALYSIS OF MELANOMA EPIDEMIOLOGICAL FROM 2016 TO 2018 PROFILE BETWEEN RACES IN MATO GROSSO STATE Autores: Flávia Ferreira Magalini / Magalini, F.F. / Hospital Amaral Carvalho; Ana Thereza Bissoli / Bissoli, Autores: Natália Santana Moreira Nunes / NUNES, N. A. T. / Hospital Amaral Carvalho; Daiana Lopes Do S. M. / UNIVAG; Rodrigo Firmino Schirmbeck Moraes Nascimento / do Nascimento, D. L. / Hospital Amaral / SCHIRMBECK, RODRIGO F. M. / UNIVAG; Rosa Maria Carvalho; Taís Menezes Magalhães / Magalhães, T. Elias / ELIAS, ROSA M. / UNIVAG; Rogério Leite Santos M. / Hospital Amaral Carvalho; Ary Assumpcao Filho / / SANTOS, ROGÉRIO LEITE / UNIVAG; José Eduardo de Filho, A. A. / Hospital Amaral Carvalho; Renato Morato Aguilar-nascimento / DE AGUILAR-NASCIMENTO, JOSÉ Zanatto / Zanatto, R. M. / Hospital Amaral Carvalho; Ana E. / UNIVAG. Gabriela Sálvio / Sálvio, A. G. / Hospital Amaral Carvalho.
Introduction: Melanoma is responsible for 4% of Introduction: Melanoma is one of the less common all malignant skin tumors. Although it is the least skin neoplasms, but it is the most aggressive one own frequent, it is considered the most aggressive due to to the high incidence of metastasis. The sentinel lymph its high rate of metastasis and lethality. Risk factors are node dissection in melanoma was first proposed in linked to exposure to carcinogens and genetics. The 1992 as an alternative to radical lymphadenectomy disease originates from melanocytes, correlating with previously advocated. The MSLT (Melanoma Sentinel epidemiology with the highest incidence in Caucasian Lymph Node Trial) I (2006) revealed the prognostic individuals. The skin is the most affected organ, most value of sentinel lymph node status. The MSLT II (2018) often in the trunk, legs, neck and face. Epidemiological evaluated the usefulness of lymphadenectomy in studies on the subject are still limited, mainly due to melanoma patients, comparing follow-up by periodic the inefficiencies of the available information systems. imaging exams with lymphadenectomy restricted to Objective: To emphasize the importance of correct clinical lymph node recurrence. Following patients for data collection to obtain satisfactory epidemiological 43 months; radical lymphadenectomy did not increase
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melanoma specific-survival among patients with positive and analyze the epidemiological and clinical-pathological sentinel lymph node, but promoted local disease characteristics of melanoma patients undergoing sentinel control. Objective: Evaluate the profile and follow-up lymph node research. Method: Descriptive retrospective of melanoma patients who underwent though sentinel exploratory study through the analysis of medical records lymph node dissection at a cancer reference service for of patients (N = 50) attended at the reference service in the last 3 years. Methods: A review of medical records Itajaí-SC, between 2012-2017. Statistical analysis of this of melanoma patients submitted through sentinel work was performed using Chi-square test and T-test. lymph node dissection performed at a public oncology Results: Sample with 100% declared white. Women 56% reference hospital from 2016 to 2018. Results: During and 44% men. The average age was 51.6 in males against the period, 133 melanoma patients underwent through 40.8. Predominant educational background: incomplete sentinel lymph node dissection. The age at diagnosis elementary school (40%). Five patients with family ranged from 15 to 87 years, distributed in 64 men (48%) history and one with previous history. The most frequent and 69 women (52%). Most of the primary lesions were location: back (34%). Incisional biopsies accounted for located in the extremities (56%), followed by trunk (37%) 16%. Histological types: extensive superficial 78% and and head/neck (7%). There was no marking in 3 of 133 nodular 22%. Sentinel lymph node biopsy was positive patients submitted to preoperative lymphoscintigraphy in 20%, and in 6% there was no radioisotope migration. and in 3 patients the sentinel lymph node was not found The preferred base, when positive, was right inguinal (n intraoperatively. The remaining 127 cases, presented an = 3) and, when negative, left axilla (n = 16). The average average of excised sentinel lymph nodes of 1.8/patient. Breslow for BLNS (-) patient was 2.41mm versus 3.98mm Micrometastasis were negative in 83 (65%) and positive (p = 0.362). Vertical growth was present in 89% in BLNS in 44 (35%). Considering 44 positive sentinel lymph (-) patients and 80% in BLNS (+). Ulceration was present nodes, 34 underwent to complete lymphadenectomy in 50% in BLNS (+), against 21.6% (p = 0.048). In both and 10 to a follow up the lymph node chain with imaging, subgroups, the highest number of mitoses ranged from following the MSLT-II. The post-lymphadenectomy 0 to 6. Conclusion: In the comparison of groups, the follow up of 34 patients, demonstrated 6 deaths from low educational level was not related to the presence melanoma, 7 lost follow-up, 5 patients alive with disease of lymph node disease. Many patients with inadequate and 16 alive without disease. The 10 follow-up patients management of the lesions (incisional biopsies) were who were not submitted trough lymphadenectomy are seen, which may have contributed to delayed diagnosis alive without disease. Conclusion: Considering post- as well as affected the evaluation of anatomopathological lymphadenectomy follow-up after positive sentinel node, variables. In the comparative analysis ulceration was a there was a higher number of patients alive than deaths. relevant factor for lymph node involvement, as well as The patients who were followed according to MSLT II tumor thickness. There was a predominance of female guidelines, all remained alive without disease; however, cases, 1.27 women diagnosed and who performed BLNS there was no significant follow-up time for comparison. for each man. The sentinel lymph node drainage base is closely related to the primary topography of the lesions. It Contato: Flávia Ferreira Magalini is also understood that there is an increase in the incidence [email protected] of melanoma worldwide, a little different from the figures found in our country, probably related to underreporting of the pathology. Further studies are needed, covering TEMÁRIO: ONCOLOGIA CUTÂNEA larger periods and larger populations groups to validate CÓDIGO: 87108 or confront these findings.
ANALYSIS OF THE EPIDEMIOLOGICAL Contato: Mariana Geraldi Rodrigues AND CLINICAL-PATHOLOGICAL PROFILE [email protected] OF MELANOMA PATIENTS UNDERGOING SENTINEL LYMPH NODE RESEARCH IN THE TEMÁRIO: ONCOLOGIA CUTÂNEA ITAJAÍ RIVER MOUTH REGION CÓDIGO: 87410 Autores: Mariana Geraldi Rodrigues / Rodrigues, M. G. / Universidade do Vale do Itajaí - UNIVALI; Gustavo Galvan ATYPICAL HAND AMPUTATION IN Debiasi / Debiasi, G. G. / Hospital e Maternidade Marieta RECURRENT SCC WITH LOCOREGIONAL Konder Bornhausen - HMMKB; Gabriela Aparecida METASTASIS: A CASE REPORT Schiefler Gazzoni / Gazzoni, G. A. S. / Universidade do Autores: Igor Duque Gonçalves da Silva / Duque, I. / Vale do Itajaí - UNIVALI; Arthur Luiz de Macedo Fressatti Universidade Federal Fluminense - UFF; Júlia Raquel / Fressatti, A. L. M / Centro Universitário das Américas Nunes Souza / Souza, J.R.N. / Universidade Federal - FAM; Isabella de Oliveira / Oliveira, I. / Universidade Fluminense - UFF; João Paulo Chevrand Latini de do Vale do Itajaí - UNIVALI; Vanessa Karlinski Vizentin / Almeida / ALMEIDA, J.P.C.L / Universidade Federal Vizentin, V. K. / Universidade do Vale do Itajaí - UNIVALI; Fluminense - UFF; Jonadab dos Santos Silva / Silva, J. S. / Bárbara Wiese / Wiese, B. / Universidade do Vale do Universidade Federal Fluminense - UFF; Danielle Basta Itajaí - UNIVALI; Fernanda Fossa Dal Piva / Dal Piva, F. Delai / Delai, D.B. / Universidade Federal Fluminense - F. / Universidade do Vale do Itajaí - UNIVALI; Fernanda UFF; Jadivan Leite de Oliveira / Oliveira, J. L / Instituto Gonçalves da Silva / Silva, F. G. / Universidade do Vale Nacional de Câncer - INCA.. do Itajaí - UNIVALI. Case Presentation: S.E.S, male, 61 years old, caucasian, Introduction: The incidence of melanoma has been native of Rio de Janeiro, farmer. He sought the oncology increasing significantly worldwide.Objective: To describe
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service in July 2018 with recurrent ulcerated lesion suggesting atypical Spitz nevus, 3 cm in size, Clark level of approximately 3 cm in the left hand with slightly IV, 2 mm thickness, perineural invasion and absence of growth, there was also ipsilateral epitroclear and ulceration. Patient was referred to wide margins excision axillary lymph node enlargement. Previous resection in and sentinel lymph node biopsy, which migrated to the February 2018, which lesion histopathology confirmed left groin region. Final pathology report demonstrated moderately differentiated squamous cell carcinoma absence of residual disease and two sentinel lymph (SCC) with compromised deep limits. Fine-needle nodes free of melanoma. - Discussion: Based on clinical aspiration biopsy of the left epitroclear lymph node and histopathological criteria, Spitz tumors can be was negative for neoplasia. On examination, patient classified as classic Spitz, atypical Spitz, and melanoma showed good general condition, with no comorbidities. Spitz. It is a rare condition with a estimated incidence Social alcoholist, denies smoking habit. Discussion: The of 1.4 to 7 new cases per 100.000 inhabitants per proposed surgery was the atypical amputation of the year. It most affects the adolescent and young adults left hand maintaining the thumb and the 5th chirodactyl, populations and usually has a benign behavior. Atypical performed in September 2018, with resection of the Spitz nevus (ASN) corresponds to a minority of cases lesion measuring 5.5 cm at the moment, musculoskeletal and its clinical relevance lies in the close histological and vasculonervous structures of the 2nd, 3rd and resemblance to invasive melanoma, with disagreement 4th left chirodactyls. The Incision was made in the left even among expert pathologists. Incidences of ASN or epitroclear region and excision of the puncture lymph melanoma in children under 9 years old are uncommon node in close contact with vasculonervous structures, and its management is often difficult and challenging. followed by the same approach to the left axillary In the reported case, characteristics such as perineural lymph node, freezing of both confirmed metastatic SCC, invasion of branch nerve > 1mm, Clark IV infiltration extending the resection margins to the deep muscle level and the presence of mitoses confer an aggressive fascia. This was followed by level I, II and III axillary histological behavior, rarely observed in this age lymphadenectomy, with removal of the lymph node group. - Final comments: Atypical Spitz nevus in a above the level of the left axillary vein. After surgery, the 6-year-old child with clinical and pathological difficulty patient proceeded with radiotherapy in the left hand, distinguishing between invasive melanoma elbow and armpit, between 2019/02/21 and 2019/03/26, progressing well clinically. Final comments: Squamous Contato: Eduardo Doria Filho cell carcinoma (SCC) is the second most common non- [email protected] melanoma skin cancer. The likelihood of developing it depends on exposure to risk factors such as solar radiation associated with age, skin type and ethnicity. TEMÁRIO: ONCOLOGIA CUTÂNEA The disease rarely becomes unresectable or metastatic, CÓDIGO: 88295 about 1 to 5% of patients with cutaneous SCC that develop locoregional or distant metastasis. In Australia, CHIRODACTILE AMPUTATION AND RETAIL a cohort of 145 patients with SCC showed that among BACK: AN ALTERNATIVE HAND AMPUTATION the most common sites of localization, the back of the hand covers only 18%, being infrequent. The patients Autores: João Paulo Chevrand Latini de Almeida general condition, the localization, the size and the / Almeida, J. P. C. L. / UNIVERSIDADE FEDERAL differentiation degree of the lesion when associated FLUMINENSE - INCA; Júlia Raquel Nunes Souza / Souza, with previous surgery would hardly lead to recurrent J.R.N. / UFF; Danielle Basta Delai / Delai, D.B. / UFF; Igor metastatic lesion, which was the opposite of what was Duque Gonçalves da Silva / Duque, I. / UFF; Jonadab Silva observed and confirmed by histopathology. / Silva, J. S. / UFF; Marcelo Sá de Araujo / Araújo, M. S. / UFF-INCA; Jadivan Leite de Oliveira / Oliveira, J. L. / INCA; Contato: Igor Duque Gonçalves da Silva Roberto André Torres de Vasconcelos / Vasconcelos, R. [email protected] A. T. / INCA.
Presentation Male patient, 67 years old, enrolled at the TEMÁRIO: ONCOLOGIA CUTÂNEA institution in December 2018 with ulceration area on CÓDIGO: 87688 the right hand back. She had a history of treatment at a primary health care unit and had undergone topical ATYPICAL SPITZ NEVUS / MELANOMA SPITZ treatment without improvement. She sought care at IN A 6-YEARS OLD CHILD: CASE REPORT another service, where she performed an incisional biopsy of the lesion and the histopathological diagnosis Autores: Eduardo Doria Filho / Doria-Filho, E / Clínica was compatible with well-differentiated squamous cell AMO; Aléssio Brunn / Brunn, G. A. R. / Clínica AMO; carcinoma, referred to the referral center. On admission Rafael Ribeiro / Ribeiro, R. S. / Clínica AMO; Adriano physical examination, he presented an ulcerated lesion Carvalho / Carvalho, A. M. P. F. / Clínica AMO; Nathanael measuring about 8 x 5 cm in the right hand dorsal region Pinheiro / Pinheiro, N. F. / IMAGEPAT; Rodrigo Guedes and hardened right armpit adenomegaly of about 2 cm. / Guedes, R. A. V. / Clínica AMO; Miguel Brandão / He underwent a new incisional biopsy that confirmed Brandão, M. A. R. / Clínica AMO. the diagnosis and the lymph node FNA was normal. His case was discussed in the “Tumor Board”, which was - Case Report: Female patient, 6 years old, mother the attempt to preserve chirodactyl if adequate surgical reporting a slowly growing melanocytic lesion on margins were achieved during the surgical procedure. abdomen skin in the last 3 years. The lesion had a He underwent disarticulation of 2nd. Right chirodactyl classic starburst shape on the dermatoscopic exam. in the proximal phalanx with volar flap reconstruction, Submitted to excisional biopsy with pathologic exam with negative margins confirmed by perioperative
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freezing examination. She had a good postoperative Método: paciente S.L, masculino, 86 anos, ex tabagista, evolution and was discharged on the first postoperative natural de Tomé-Açu, no Pará, apresentou há cerca de day. Four months after surgery, the patient reports good 1 ano, lesāo ulcerada em região escapular esquerda, right-hand motor function and preserved sensitivity. se estendendo para região superior do ombro com Discussion Epidermoid carcinomas of the extremity are a invasão óssea. Realizou biópsia em agosto de 2015, difficult entity to conduct. Often their clinical presentation evidenciando Carcinoma de Células Escamosas G2 is confused with benign pathologies, and specific infiltrativo. Encaminhado para realizar seguimento e treatments are initiated without clinical resolution. Often, tratamento especializado. Apresentava lesāo extensa, only after the therapeutic failure associated with lesion ulcerada e sangrante, localizada em face anterior de growth is the diagnosis suspected. Exudative ulcerated ombro esquerdo e região escapular, com quadro de lesions located in the extremities without improvement dor intensa e limitação de movimentos. O paciente with the proposed treatment should be biopsied and if foi submetido a ressecçāo da lesāo pela cirurgia de the diagnosis is confirmed, the patient should be referred Tikhoff-Limberg. Resultado: o paciente apresentou to a referral center or to a professional with expertise in satisfatória evolução no pós operatório, com boa the treatment of this type of cancer. Often, the lesions cicatrização de ferida. Recebeu reabilitação com o progress with an exponential increase of their lesions, auxilio da fisioterapia motora, conseguindo realizar becoming a challenge for conservative surgery, in order suas atividades diárias com poucas restrições. No to maintain the functionality of the limbs, allowing exame histopatológico da peça cirúrgica, evidenciou patients undergoing preservative surgery to have a Carcinoma Epidermóide pouco diferenciado, infiltrando good quality of life. comments Patients with cutaneous planos musculares e ósseos, com margens livres, sem neoplasia should be referred to specialized centers for invasão angiolinfática e peri neural. Conclusão: O the treatment of this condition, so we hope that the Carcinoma de Células Escamosas representa cerca de recurrence rates will decrease and that we will have 20% dos cânceres de pele. Tem origem da camada mais more possibility of performing functional preservative superficial da epiderme, geralmente aparece nas áreas surgeries. do corpo expostas ao sol, porém, pode surgir também em cicatrizes ou feridas crônicas de pele em qualquer Contato: João Paulo Chevrand Latini de Almeida região do corpo. Comparando com o carcinoma [email protected] basocelular, o CEC possui risco maior de invasão de camadas profundas e metástase para outros órgãos.
TEMÁRIO: ONCOLOGIA CUTÂNEA Contato: Rodrigo Custódio Rodrigues de Aguiar CÓDIGO: 87272 [email protected]
CIRURGIA DE TIKHOFF-LINBERG PARA CARCINOMA DE CÉLULAS ESCAMOSAS TEMÁRIO: ONCOLOGIA CUTÂNEA CÓDIGO: 87309 LOCALMENTE AVANÇADO, REALIZADA EM HOSPITAL DE REFERÊNCIA NA AMAZÔNIA CUTANEOUS MALIGNANT CHONDROIDSY- Autores: Rodrigo Custódio Rodrigues de Aguiar / RINGOMA (MSC): A CASE REPORT OF INITIAL Aguiar, R. C. R. / Hospital Ophir Loyola; Rodrigo L. F. ASSESSMENT WITH NODAL RELAPSE AND Santos / Santos, R. L. F. / Hospital Ophir Loyola; Lorena LITERATURE REVIEW L. M. N Fernandes Loureiro / Loureiro, L. L. M. N. F. / Hospital Ophir Loyola; Victor F. Ferreira / Ferreira, V. F. Autores: Alex de Albuquerque Lins Barbosa / Barbosa, / Hospital Ophir Loyola; Fábio A. Morikawa Caldeira / A.A.L. / AC Camargo Câncer Center; Rute Facchini Lellis Caldeira F. A. M. / Hospital Ophir Loyola; Rafael Maia de / Lellis, R.F. / AC Camargo Câncer Center; Clóvis Antônio Sousa / Sousa, R. M. / Hospital Ophir Loyola. Lopes Pinto / Pinto, C.A.L. / AC Camargo Câncer Center; Antonio Cássio Assis Pellizzon / Pellizzon, A.C.A. / AC Introdução: As amputações e as desarticulações Camargo Câncer Center; Eduardo Bertolli / Bertolli, E. foram os procedimentos clássicos para o tratamento / AC Camargo Câncer Center; Flavio Texeira Rodrigues de tumores até a década de 70. Esses procedimentos Filho / Filho, F.T.R. / AC Camargo Câncer Center; João eram realizados devido à falta de drogas antiblásticas, Pedreira Duprat Neto / DupratNeto, J.P. / AC Camargo que auxiliariam no tratamento do tumor primário. Câncer Center. Nos últimos tempos, com o aparecimento de drogas eficazes, foi possível realizar inúmeros tipos de We report a case a 67-year-old woman with a slow cirurgias buscando a preservaçāo dos membros, growing nodular lesion in lower left limb, which sem prejuízo funcional, apresentando melhora na excisional biopsy showed Malignant chondroid qualidade de vida dos pacientes. Casos selecionados syringoma (MCS) with positive margins, requiring a new de tumores da cintura escapular ou de origem cutânea approach for wide local excision in 2013. She remained com invasāo de cintura escapular podem ser tratados in follow up for over 48 months, when she presented pela cirurgia de Tikhoff- Linberg, sendo uma alternativa with a groin nodule in 2017. Fine-needle aspiration was à amputação interescapulotorácica (AIET). Objetivo: compatible with metastatic MCS. Abdominal and pelvic Relatar o caso de um paciente com tumor localmente tomography showed inguinal and external iliac lymph avançado, em ombro esquerdo, onde foi realizada a node enlargement. She underwent surgery and ilio- cirurgia de Tikhoff-Linberg (Ressecçāo Inter-escápulo- inguinal dissection showed 7/14 affected lymph nodes, torácica), com preservação do membro. O relato 5 of them with extracapsular extravasation (EEC). Three inclui aspectos clínicos, diagnósticos e terapêuticos. dimensional adjuvant radiation therapy (48Gy in 20 daily
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fractions, over 4 weeks) was given as adjuvant treatment radiotherapy (6x700cGy) twice a week. Discussion: for ilio-inguinal region. She is about to complete one The eye is a rare site of systemic disease in cases of year after surgery and latest imaging have shown no cutaneous melanoma and the estimate is only 0.5 1% evidence of disease. She reports good quality of life of intraocular metastasis originate from this primary without limitations or edema. Management of MCS tumor and intraorbital lesions occur less frequently includes wide excision of the primary tumor, whereby than those to the eyeball. Usually patients with this it was done of the primary tumor. Nodal recurrence type of metastasis already have systemic disease when was treated with surgery and adjuvant radiotherapy the first ocular manifestations occur and the clinical due to EEC, despite the role of adjuvant radiotherapy presentations vary, depending on the site involved. and/or chemotherapy in preventing local recurrence Patients were treated by different protocols, the best or metastatic disease still to be defined. MCS is a rare results were obtained with circumscribed radiotherapy condition and multidisciplinary approach is essential or external irradiation, depending on the site and extent for achieving better results. of the lesion. Overall survival and disease-free survival rates are low and depend on disease staging at primary Contato: Alex de Albuquerque Lins Barbosa presentation, site of recurrence, disease-free interval, [email protected] tumor thickness, ulceration, and response to initial therapy for recurrence. Final comments: Unfortunately, the survival rate in patients with metastatic cutaneous TEMÁRIO: ONCOLOGIA CUTÂNEA melanoma is low, averaging less than 9 months. Early CÓDIGO: 87915 detection of disease relapse is assumed to be a positive factor for treatment and further survival, however this CUTANEOUS MELANOMA WITH SYSTEMIC concept has not been proven even with the use of more DISEASE PRESENTATION IN THE EYELID: effective advanced melanoma therapies. A CASE REPORT FROM THE BRAZILIAN Contato: Renata Maravieski Pareja NORTHWEST [email protected] Autores: Renata Maravieski Pareja / Pareja, R.M. / Universidade do Estado do Amazonas ; Lailson Melgueira Navarro / Navarro, L.M. / Universidade do TEMÁRIO: ONCOLOGIA CUTÂNEA CÓDIGO: 87799 Estado do Amazonas; Rejaine Ribeiro Vilela / Vilela, R.R. / Universidade Nilton Lins; Leandro Castro Breves / Breves, L.C. / Universidade do Estado do Amazonas; DERMATOFIBROSARCOMA PROTUBERANS Sarah Susan Rodrigues Tavares / Tavares, S.S.R. / METASTATIC AND WITH MULTIPLE Universidade Federal do Amazonas; Márcio Neves RECURRENCES Stefani / Stefani, M.N. / Fundação Centro de Controle de Oncologia do Estado do Amazonas; Adriana Aranha Autores: Gabrielly Saraiva Porto Garcia / Garcia, G. S. Pereira Machado / Machado, A.A.P. / Fundação Centro P. / Universidade Federal do Estado do Rio de Janeiro de Controle de Oncologia do Estado do Amazonas; (UNIRIO); Antonio Felipe Santa-maria Coquillard Ayres Maxine Aguiar Damasceno / Damasceno, M.A. / / Santa-Maria, A. F. / Universidade Federal do Estado Universidade do Estado do Amazonas; Angeli Alexandra do Rio de Janeiro (UNIRIO); Vitor Yu Zhu / Zhu, V. Y. / Caro Contreras / Contreras, A.A.C. / Universidade do Universidade Federal do Estado do Rio de Janeiro Estado do Amazonas; Larissa Pessoa de Oliveira / De (UNIRIO); Manuella Caroline Dutra Frazão Alves / Oliveira, L.P. / Universidade Federal do Amazonas. Frazão, M. C. D. A. / Universidade Federal do Estado do Rio de Janeiro (UNIRIO); Beatriz Escudeiro Nascimento Case Presentation: A 67-year-old caucasian male / Nascimento, B. E. / Universidade Federal do Estado from Amazonas returns to the Oncology Center do Rio de Janeiro (UNIRIO); Leonardo Cruz Gomes / after previous diagnosis and treatment with surgical Gomes, L. C. / Universidade Federal do Estado do Rio de resection of calf melanoma back in 2015 and Janeiro (UNIRIO); Laura Pereira Guimarães / Guimarães, recurrence in the right thigh in 2016. In December L. P. / Universidade Federal do Estado do Rio de Janeiro 2017, he presents another lesion in the right cervical (UNIRIO); Mariana Quintela Rodrigues Pereira / Pereira, region, started treatment with Pembrolizumab with M. Q. R. / Universidade Federal do Estado do Rio de minimal response. Currently with disseminated disease Janeiro (UNIRIO). unresponsive to immunotherapy and expansive left orbit lesion progressing for four months. In good M.T.S.S., female, 61 years old, in 2011 was diagnosed general condition, reports controlled pain, bleeding and with dermatofibrosarcoma protuberans (DFSP) inter foul odor in the region. Physical examination shows an pectoral region. Had previously been submitted to 3 8cm lesion in the left orbit. Referred to radiotherapy surgical interventions without success. In May of 2014, service due to active bleeding and necrosis. Cranial MRI she presented a recurred tumor invading the inferior showing lesion with an enlargement of approximately part of the sternum, confirmed by incisional biopsy 16cm over a three-month interval (2.9cm to 19cm), and tomography didnt show metastatic disease. In with epicenter in the anteromedial corner of the left June of 2014, a wide resection of the lesion was made, orbit, extending posteriorly with bony erosion of the monoblock of the distal part the underlying sternum papyraceous lamina, involving ethmoidal cells, lateral and a piece of the thoracic-abdominal wall. The defect compressive effect of orbital structures, as well as was corrected with a surgical screen and medial breasts the eyeball and multiple lesions sparsely distributed advance scraps. The margins were free, the smallest throughout the brain. He is receiving 42Gy palliative measured 5 cm, without adjuvant therapy. There were
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no post-surgery complications and the patient continued sartório e pectínio, medindo 10x3.8x11 cm. Nota-se in outpatient care for 2 years, when multiple, diffuse and íntimo contato com artéria e veia femorais superficiais, bilateral pulmonary metastasis showed, evolving to her sem sinais aparentes de invasão. Linfonodomegalias death. There were no signs of local recurrence. DFSP is a nas cadeias ilíaca externa e inguinal a direita. Na rare type of sarcoma that appears in middle age adults, angiotomografia nota-se íntimo contato com a artéria originated from the skin, it infiltrates soft tissues, with femoral superficial direita na sua porção proximal em a high tendency of recurrence and a preference for the menos de 180º. Paciente foi submetido a ressecção torso and extremities. A slow growing tumor with low tumoral em raiz da coxa, com achado de infiltração metastatic potential but, if occurred, the most likely are dos vasos femorais, sendo realizado enxerto com the pulmonary ones. Currently, the surgical excision of veia safena contralateral e realizado ainda rotação de the lesion, primary or recurrent, is the main approach retalho fasciomiocutâneo do reto abdominal. Evoluiu due to the accessibility of the procedure. It needs to no pós-operatório com dor intensa constante e edema leave free margins of 1 to 5 cm and a new approach do membro. No 9° PO cursou com cianose de membro must be made if theyre compromised. Radiotherapy is inferior, piora da dor e edema. Feito USG doppler que suggested in cases deemed inoperable, with multiple identificou inviabilidade do enxerto, sendo necessária recurrences or in surgeries with inadequate margins. desarticulação do membro. Após desarticulação Usually presents a good prognosis of survival in 5 years, paciente teve boa evolução, recebendo alta hospitalar no reaching 97%. DFSP is a tumor with locally aggressive 5° PO da desarticulação. No seguimento ambulatorial, behavior, associated with a high rate of loco-regional recebido anatomopatológico da primeira cirurgia com metastasis, especially if surgical margins are inferior margens livres, assim como da peça da desarticulação. than 3 to 5 cm, contrary to most soft tissue sarcoma, Paciente permanece em acompanhamento when a 2 cm free margin is enough. Due to wide ambulatorial, até o momento sem sinais de recidiva resections, the esthetic reconstruction is a challenge tumoral. Discussão: Carcinoma epidermóide é o on its own. Despite multiple techniques described for segundo câncer de pele mais prevalente, ocorrendo the reconstruction of the thoracic-abdominal wall, we principalmente em áreas de pele expostas aos raios showed with this case that the movement of the breasts solares, porem pode acometer qualquer área. Há a through simple patchwork by advance, showed itself relação, também, com feridas crônicas e cicatrizes de to be a safe, doable and with a satisfactory cosmetic pele. É importante ressaltar que o sexo masculino é result. In conclusion, we emphasize that systemic acometido numa proporção de 2:1 quando comparado metastasis, although rare, can occur and surgery can be ao sexo feminino. Comentários finais: O sucesso contemplated. The reported patient showed countless terapêutico de carcinoma epidermeóide depende pulmonary metastasis and did not have clinical de diversos fatores, dentre eles o nível de invasão da conditions for the procedure. lesão, visto que pequenas lesões exigem ressecções de menores extensões portanto com menos riscos de Contato: Gabrielly Saraiva Porto Garcia complicações. [email protected] Contato: Carolina Mayumi Yamanaka [email protected] TEMÁRIO: ONCOLOGIA CUTÂNEA CÓDIGO: 87089 TEMÁRIO: ONCOLOGIA CUTÂNEA DESARTICULAÇÃO DE MEMBRO INFERIOR CÓDIGO: 88062 PÓS RESSECÇÃO TUMORAL E ENXERTIA VASCULAR EM HOSPITAL DE REFERÊNCIA EM EVALUATION OF THE APPLICABILITY OF THE ONCOLOGIA NO ESTADO DO PARÁ BRAZILIAN FEDERAL LAW 12.732 IN PATIENTS WITH MELANOMA AND IN THE CANCER Autores: Carolina Mayumi Yamanaka / YAMANAKA, C. OUTCOME M. / HOL; Rafael Maia de Sousa / SOUSA, R. M. / HOL; Victor de Freitas Ferreira / FERREIRA, V. F. / HOL; Matheus Autores: Bruno Aquino Marcelino / Marcelino, B.R. / Henrique de Souza Gomes / GOMES, M. H. S / HOL; Faculdade Ciências Médicas de MInas Gerais; Fernanda Amanda Raminho Luz / LUZ, A. R. / HOL; Ananda Nunes Hermeto Soares / Soares, F.H. / Faculdade Ciências de Jesus / JESUS, A. N. / HOL; Luna D‘angelis Barbosa de Médicas de MInas Gerais; Marcela Lima Castro Curi / Albuquerque / ALBUQUERQUE, L. D. B / HOL; Thyago Curi, M.L.C. / Faculdade Ciências Médicas de MInas Cezar Prado Pessoa / PESSOA, T. C. P. / HOL; Rubens Gerais; Alberto Julius Alves Wainstein / Wainstein, A.J.A. / Fernando Gonçalves Ribeiro Júnior / JUNIOR, R. F. G. R. / Faculdade Ciências Médicas de MInas Gerais; Ana Paula HOL; João Vinicius Pinheiro de Silva / SILVA, J. V. P. / HOL. Drummond-lage / Drummond-Lage, A.P. / Faculdade Ciências Médicas de MInas Gerais. Apresentação do caso: R.S.B., 22 anos, sexo masculino, natural de Belém, paciente com lesão em Introduction: The Brazilian Federal Law number raiz de coxa direita há 7 meses, associada dor intensa 12.732, from the 22nd of November 2012, gives the local. Exame físico: lesão úlcero-vegetante medindo right to the patient with a cancer diagnosis, confirmed aproximadamente 20cm de diâmetro no maior eixo em by anatomopathological report, being submitted to porção anterior da raiz da coxa direita, apresentando the first treatment at SUS (Sistema Único de Saúde, in odor fétido, pulsos distais normais. Histopatológico: Portuguese), within 60 days from the date the diagnosis carcinoma epidermoide. Realizado tomografia de pelve was firmed. The early detection is a strategy to reduce evidenciando lesão infiltrativa envolvendo os músculos cancer stage and enables curative treatment. It is
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important to understand SUSs patients with oncological Rio de Janeiro (UNIRIO); Beatriz Escudeiro Nascimento / diagnosis and the time of the beginning of treatment Nascimento, B. E. / Universidade Federal do Estado do to evaluate public health policies and the interventions Rio de Janeiro (UNIRIO). adopted. Melanoma patients may suffer from metastasis, either because of tumoral growth, or due A.C.S, male, 65 years old, with significant cardiac to the extended time between diagnosis and treatment disease and an extensive history with sun exposure, start. At an early stage, surgical excision of melanoma refers the appearance of pruritic, erythematous, scaly represents possibility of remission and cure. Objective: lesion with shallow ulcerations in the right eyebrow To evaluate if the Brazilian Federal Law number 12.732 in the beginning of 2016. Submitted to an immediate is fulfilled and its relation with a melanoma diagnosis incisional biopsy of the lesion, that showed basal cell and the patients oncological outcome. Methods: The carcinoma (BCC). He was initially treated in another study consists on a quantitative retrospective cohort institution with a shaving of the lesion, associated based on data collection analyzing medical records with the use of 5-Fluorouracil (5-FU) topic, for 21 days. from all the patients with melanoma diagnosis in the The option for ablative therapy was due to his severe period from January of 2013 until December of 2014, cardiologic case. However, these measures did not who were submitted to any oncological treatment. The succeed, occurring the local progression of the lesion medical records during the five-years follow-up were in the next 3 years. In 2019 the lesion occupied the also analyzed. The data was collected from a public entirety of the left front-temporal region. It became health institute in Belo Horizonte, Minas Gerais. Results: necessary a wide resection and a primary closing. The During the first two years of the Brazilian Federal Law analysis of the surgical specimen confirmed the original number 12.732, there were 74 new cases of melanoma diagnose and showed free and ample margins. At the designated to the service mentioned, between men moment the patient continues in outpatient care and and women. Of this total, 41 patients (55,5%) had their doesnt show signs of tumor recurrence. BCC is the treatment started within the period of 60 days, as most common cancer in the world, its incidence has established by the law, while 33 patients (44,5%) started grown in the last few decades due to a life style of more treatment belatedly. In the group of the patients treated sun exposure, mainly ultraviolet B rays. The superior accordingly to the law, there were 8 deaths during the part of the face is the main location that the tumor 5 years following the diagnosis date, unlikely what was appears, it can be highly destructive and disfiguring, seen in the other group. Conclusion: The Brazilian and rarely causes metastasis. The primary therapeutics Federal Law number 12.732 aims diagnosis and early would be the surgical excision of the lesion, where it treatment of patients with cancer. It was expected that could be associated with radiotherapy in cases where the group submitted to treatment in the first 60 days the margins are compromised and re-operating is would present better survival rate and lowest death contraindicated. The therapy with topic 5-FU can also rate when compared to the other group. Considering be used with superficial BCC when there is no possibility melanoma, it can be noticed that early diagnosis of surgery, with a total regression in 90% of cases but and the Breslow are still the most relevant prognosis with a higher possibility of recurrence than the surgical factors, considering that the group of patients with late resection. The prognosis is considered very good, with treatment presented lower death rate, once the cancer a cure rate surpassing 90% but there are cases with had been diagnosed in an early stage. important local morbidity on account of the infiltrative behavior of the tumor and the healing operations that Contato: Bruno Aquino Marcelino mutilate the region. The non-melanoma skin cancers, [email protected] despite having a low morbidity-mortality rate, are very frequent and their inadequate approach can create great deformities, due to the direct destruction by the TEMÁRIO: ONCOLOGIA CUTÂNEA tumor or the radical surgical procedure. The resection CÓDIGO: 87821 with free margins is the gold standard but ablative therapies can be used in selected situations. In the EXTENSIVE FACE BASAL CELL CARCINOMA: A presented case, the association of scraping of the CASE REPORT AND LITERATURE REVIEW lesion + topic chemotherapy was not able to contain the progression of the lesion in medium term. Autores: Gabrielly Saraiva Porto Garcia / Garcia, G. S. P. / Universidade Federal do Estado do Rio de Janeiro Contato: Gabrielly Saraiva Porto Garcia (UNIRIO); Antonio Felipe Santa-maria Coquillard Ayres [email protected] / Santa-Maria, A. F. / Universidade Federal do Estado do Rio de Janeiro (UNIRIO); Mariana Quintela Rodrigues Pereira / Pereira, M. Q. R. / Universidade Federal do TEMÁRIO: ONCOLOGIA CUTÂNEA Estado do Rio de Janeiro (UNIRIO); Sávio Otto Schneider CÓDIGO: 87818 Motta / Motta, S. O. S. / Universidade Federal do Estado do Rio de Janeiro (UNIRIO); Danielle Rodrigues Neves FIVE-YEAR DELAY ON PRIMARY CUTANEOUS da Costa / Costa, D. R. N. / Universidade Federal do Estado do Rio de Janeiro (UNIRIO); Sérgio Perez Júnior MELANOMA DIAGNOSIS AND SURVIVAL / Júnior, S. P. / Universidade Federal do Estado do Rio IMPACT de Janeiro (UNIRIO); Antonio Pedro Lima Costa Pereira Autores: Bruno Aquino Marcelino / Marcelino BA / Pereira, A. P. L. C. / Universidade Federal do Estado do / Hospital Alberto Cavalcanti, FHEMIG; Ana Paula Rio de Janeiro (UNIRIO); Manuella Caroline Dutra Frazão Drummond-lage / Drummond-Lage, A.P. / Faculdade / Frazão, M. C. D. A. / Universidade Federal do Estado do Ciências Médicas de Minas Gerais; Maria Cavallieri Diniz
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/ Diniz, M.C. / Oncad; Alberto Julius Alves Wainstein / Brittes, L. / Universidade de Passo Fundo; Renata Bruna Wainstein, A.J.A. / Hospital Alberto Cavalcanti, FHEMIG. Garcia dos Santos Gatelli / Gatelli, R. B. G. S. / Hospital de Clínicas de Passo Fundo; Charles Nilton Gatelli / Case Report: A 54-year female, leukoderma, sought Gatelli, C. N. / Hospital de Clínicas de Passo Fundo; ícaro medical care in 2009 due to a spot on her right leg, de Azevedo Alexandre / Alexandre, I. A / Universidade which dermatological evaluation considered as Federal da Fronteira Sul; Letícia Signori Kohl / Kohl, L. S a benign lesion. In 2011, patient went to another / Universidade Federal da Fronteira Sul. service with the same complaint, motivated by a skin cancer prevention campaign, and had the lesion Woman, 24 years old, referred to a cancerology cauterized in the occasion. In 2012, the lesion became department due to the appearance of diffuse tumoral pruritus and presented relief increase, leading the lesions of the body, progressively growing, 8 years patient to seek care again, this time at an UBS (Basic ago. She reports previous injury excision and denies Health Unity, in Portuguese). She was then referred similar family history and other comorbidities. Physical to a Dermatologist, and eleven months later was examination shows multiple tumoral lesions on the attended by one, who did not find any dermatological face and trunk, suggestive of basal cell carcinoma, and changes. Patient then requested referral to perform palmar and plantar depressions. Tomography showed lesion excision, and after being examined by three an image suggestive of odontogenic keratocyst, other doctors, underwent biopsy in 2014. The confirmed by histopathological analysis. A total of anatomopathological report indicated superficial 27 lesions were excised, with a report compatible extensive melanoma, with 1,5cm diameter, in vertical with expansive and infiltrative ulcerated nodular phase of growth, classified as Clark level IV and basal cell carcinoma. Diagnosis compatible with 3,5mm Breslow. She underwent surgery for margin Gorlin-Goltz Syndrome (GGS). SGG is an autosomal widening and sentinel lymph node biopsy, followed dominant inherited disease caused by PTCH1 gene by right inguinal lymphadenectomy in 2015. In 2016, mutation, predisposing to developmental anomalies patient evolved with subcutaneous nodes and in and tumors. It also affects men and women, with a 2017 a computed tomography showed and important prevalence of 1/164000, and the recognition of the increase on both adrenals size. Also, in 2017, an MRI pathology before adolescence is rare. The diagnosis (magnetic resonance imaging) evidenced a right is made in the presence of at least two major criteria parasagittal parietal expansive lesion, which extended or one major and one minor criterion. The major to the nasal fossa, and in November of the same year criteria being: two or more basal cell carcinomas or patient died. Discussion: Early melanoma diagnosis is one under the age of 20 years, proven keratocystic related to a greater healing potential, greater survival odontogenic tumor, three or more palmar or plantar rate and lower treatment expenses. However, many depressions, bilamilar cerebral scythe calcification, patients are diagnosed with advanced disease, as bifid, fused or flattened ribs, and first-degree relatives shown in this case report, with the diagnosis being the syndrome. The minor ones are: macrocephaly, made 5 years after the appearance of the first lesion. congenital malformations (cleft lip or palate, frontal The reasons for belated diagnosis include patient- bosses, moderate to severe hypertelorism), skeletal related factors, as the lack of information regarding anomalies (Sprengel deformity, deformed chest, the illness, and also the lack of experience by health hemivertebrae, fusion or elongation of vertebral care professionals, the exaggerated number of bodies, hand and foot defects, syndactyly , bone referrals, or insecurity to give a melanoma diagnosis cysts in the hands), puncture of the saddle, ovarian by the professionals. Final considerations:This case fibroma and medulloblastoma. Tumor excision is report is an example of early diagnosis obstacles, the treatment of choice. Topical therapies such as a representation of the excessive amount of non- 5-fluorouracil and imiquimode may also be used, resolutive referrals and also inadequate melanoma with targeted therapy reserved for recurrent, treatment. Thus, it is important to enhance and locally advanced or metastatic cases. Frequent enlarge educative campaigns regarding melanoma dermatological surveillance, radiological screening and other skin cancer types prevention, aiming both for medulloblastoma in children under 8 years and population and health care professionals, enabling for keratocystic odontogenic tumor are required patients to undergo appropriate treatment. annually. Early discovery of GGS is critical and allows conservative therapies to be used. Diagnosis and Contato: Bruno Aquino Marcelino treatment of the syndrome require a multidisciplinary [email protected] approach, followed by genetic counseling and long- term clinical and radiological follow-up.
TEMÁRIO: ONCOLOGIA CUTÂNEA Contato: Mariana Gregorio CÓDIGO: 87691 [email protected]
GORLIN-GOLTZ SYNDROME: CASE REPORT TEMÁRIO: ONCOLOGIA CUTÂNEA Autores: Mariana Gregorio / Gregorio, M. / Universidade CÓDIGO: 88078 Federal da Fronteira Sul; Bruna Schmitt Puhl / Puhl, B. S. / Universidade de Passo Fundo; Elisa Estivalete HIDRADENOCARCINOMA: A RARE CASE Jablonski / Jablonski, E. E. / Universidade de Passo Fundo; Fernanda Schafer / Schafer, F. / Universidade REPORT de Passo Fundo; Fernanda Pinho Tagliari / Tagliari, F. Autores: Renata Maravieski Pareja / Pareja, R.M. P. / Universidade de Passo Fundo; Laurenlisiê Brittes / / Universidade do Estado do Amazonas; Lailson
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Melgueira Navarro / Navarro, L.M. / Universidade do TEMÁRIO: ONCOLOGIA CUTÂNEA Estado do Amazonas; Rejaine Ribeiro Vilela / Vilela, CÓDIGO: 87794 R.R. / Universidade Nilton Lins; Angeli Alexandra Caro Contreras / Contreras, A.A.C. / Universidade do Estado INTERSCAPULOTORACTIC DISARTICULATION do Amazonas; Larissa Pessoa de Oliveira / de Oliveira, IN A PATIENT WITH SQUARESE CUTANEOUS L.P. / Universidade Federal do Amazonas; Sarah Susan Rodrigues Tavares / Tavares, S.S.R. / Universidade CUTANEOUS CARCINOMA MARJOLIN‘S Federal do Amazonas; Manoel Jesus Pinheiro Coelho ULCERA: A CASE REPORT Junior / Coelho Junior, M.J.P. / Fundação Centro de Autores: Luciana Mata da Silva / Mata, L.S / Hospital de Controle de Oncologia do Estado do Amazonas; Câncer de Pernambuco; Cecília Araújo Carneiro Lima / Rosanne Arruda Lemos / Lemos, R.A. / Universidade de Lima, C.A. / Hospital do Cancer de Pernambuco; Ingrid Rio Verde. Kelly de Lima Cavalcanti / Cavalcanti,I.K. / Universidade Maurício de Nassau; Anna Nathália de Oliveira Cavalcanti Case Presentation: A 51-year-old female patient Medeiros / Medeiros, A.N. / Universidade Maurício from Manaus (AM) reports the appearance of de Nassau; Lorena Karla Cruz Lucena / Lucena, L.K / subcutaneous nodulation in the gluteal region in Universidade Maurício de Nassau; Christine Marques 2017, a surgical excision was performed in May de Miranda / Miranda, C.M / Hospital de Câncer de. 2018 at a Dermatology center, referred after 4 months to the Oncologic Surgery service after Case Presentation: A 34-year-old woman, who had a third immunohistochemistry (IHC) compatible with degree burn at the age of six, presented a rapidly growing, hidradenocarcinoma. Computed tomography (CT) painful, exophytic, ulcerated, infected, and friable lesion suggested an image of deep inguinal lymph node that affected the ipsilateral right shoulder, thorax, and disease, and a right inguinal lymphadenectomy was armpit. Magnetic resonance showed an expansive process performed and the histopathologic examination involving the skin and subcutaneous cellular tissue of the confirmed the disease presentation. Patient upper anterior face of the right hemithorax, extending to returns to service complaining of lower back pain the axillary region and internal face of the homolateral associated with lower limb stings. A pelvic magnetic arm, suggestive of cutaneous neoplasia, as well as lymph resonance imaging (MRI) was performed, showing a node enlargement in the axillary, supraclavicular and heterogeneous expansive and infiltrative lesion, along brachii bilaterally. Histopathological analysis revealed the right sartorius muscle pathway of approximately well differentiated squamous cell carcinoma (SCC). She 9.1 x 4.1 x 2.8cm. Abdominal computed tomography underwent interscapulothoracic disarticulation with (CT) on 02/04/2019 presents a hypodense nodular oval right axillary dissection, followed by reconstruction with formation in the right inguinal region measuring 3.7 x myocutaneous flap and free skin graft. Analysis of the 2.4cm with adjacent subcutaneous densification, skin surgical specimen: Well-differentiated SCC with pT3N0M0 thickening associated with adjacent subcutaneous stage. After 8 months, she presented locoregional densification in the right lumbar region. Chest recurrence, however, a new surgical approach would be of computed tomography (CT) showing a solid nodule great morbidity and the patient evolved with a good quality in the upper segment of the right lower lobe of the of life. Discussion: Marjolin‘s ulcer is a rare cutaneous right lung of 1.1 x 0.9 cm, hilar calcified lymph nodes malignancy associated with an earlier insult and its main and in the right paratracheal chain. She is currently in cause is burn. The diagnosis is histological, being the most palliative treatment with cisplatin (CPPD) and external common type of malignancy the SCC, are more aggressive radiotherapy. Discussion: Hidradenocarcinoma lesions and with higher metastatic potential. Malignant is a rare tumor caused by abnormal sweat gland transformation occurs in 0.1-2.5% of chronic wounds, cell growth, accounting for less than 0.01% of all tending to be slow and with a time interval between insult skin cancers. Usually presents a slow growing and tumor appearance between 30 and 35 years. The and painless, but infiltration of adjacent tissues is average age of presentation was between 50.0 ± 4.2 years. common, especially for lymph nodes or present with The most commonly involved sites are the extremities systemic disease. The diagnosis is usually made by (58%). The basis of treatment is surgical resection. Skin or physical examination and skin tests. Because it is a flap graft reconstruction is decided by the site of injury, rare etiology, there are no established guidelines for although most studies advocate skin graft for better its treatment. The most commonly used treatment is follow-up and detection of recurrence. Radiotherapy surgical exeresis, but its often associated with lymph is considered to prevent amputation and aesthetic node or systemic disease, some protocols suggest deformity or as adjunctive therapy to reduce regional adjuvant treatment with chemotherapy and / or recurrence. Chemotherapy is not yet well established. The radiotherapy. Hidroadenocarcinomas are known to risk of recurrence ranged from 20% to 50% (average 33%) be aggressive tumors and have high rates of local and five-year survival was 40 to 60% (average 52%). Major recurrence and systemic disease. Isolated surgical risk factors for metastasis are histological grade and treatment has 5-year survival rates below 30% and tumor size. Final considerations:The scientific relevance the chance of disease recurrence is greater than is based on the scarcity of reports in the literature, as well 50%. It is still uncertain whether the association of as on the fact that the malignancy of Marjolin‘s ulcer is radiotherapy and chemotherapy prolong the statistics uncommon, which makes management difficult in cases of these patients. of advanced disease.
Contato: Renata Maravieski Pareja Contato: Cecília Araújo Carneiro Lima [email protected] [email protected]
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TEMÁRIO: ONCOLOGIA CUTÂNEA TEMÁRIO: ONCOLOGIA CUTÂNEA CÓDIGO: 87789 CÓDIGO: 88067
INTESTINAL INTUSSUSCEPTION BY META- ISOLATED LIMB PERFUSION IN TREATMENT STATIC MELANOMA IN SMALL INTESTINE - OF LOCALLY ADVANCED MELANOMA: STILL CASE REPORT A THERAPEUTIC OPTION IN 2019 IN BRAZIL - Autores: Fernanda Alonso Rodriguez Fleming / Fleming, CASE REPORT F. A. R. / INCA; Ketheryn Adna Souza de Almeida / Autores: Alberto Julius Alves Wainstein / Wainstein, Almeida, K. A. S / INCA; Vinicius Pessoa Galvão / Galvão, A.J.A. / Faculdade Ciências Médicas de Minas Gerais; V. P. / INCA; Marcelo Sá de Araújo / Araújo, M. S. / INCA; Everton Otávio Flores Ferrão / Ferrão, E.O.F. / Faculdade Jadivan Leite de Oliveira / Oliveira, J. L. / INCA. Ciências Médicas de Minas Gerais; Rodrigo Souza Sarmento Valente / Valente, R.S.S. / Faculdade Ciências Case Presentation: Female patient, black, 45 years Médicas de Minas Gerais; Ana Paula Drummond-lage / old, diagnosed with melanoma in Jul/17, primary Drummond-Lage, A.P. / Faculdade Ciências Médicas de lesion in palatine tonsil, stage IV with lymph node Minas Gerais. and pulmonary metastasis. She had Dacarbazine chemotherapy until Jan/18. It evolved with disease Case Presentation: A 61-year-old male patient progression. Reintroduced Dacarbazine until Jun/19 with melanoma, stage IIIb on the left foot, was with partial response. Hospitalized in Jul/19 with diagnosed in 2010. He underwent margin excision bowel obstruction and tomography compatible with and left inguinal emptying in the same year. After intestinal intussusception. The patient underwent three years of follow-up, he had a locoregional surgical treatment and an intraluminal jejunal recurrence. He underwent radiotherapy, two tumor lesion at 20 cm from the Treitz angle was chemotherapy regimens with partial response identified, causing jejuno-jejunal intussusception. and new local relapse, with no evidence of distant Segmental enterectomy with anastomosis was disease. In June 2019, the patient was referred to performed. Anatomopathological report confirmed Oncologic Surgery for isolated limb perfusion (ILP) metastatic melanoma with free surgical margins. due to lack of access to systemic treatment based on Postoperative period with good clinical evolution target drug or immunotherapy. In the perioperative and no complications. Proceed oncological control. period, after isolating the limb in the extracorporeal Discussion: Melanoma is an uncommon skin cancer, circuit, the patient maintained systemic escape, representing 3% of all malignant skin neoplasms. making chemotherapy unfeasible. The venous leak Despite its low incidence, it is reponsable for about was identified through the small saphenous vein 2/3 of deaths in this group. It may behave aggressively with radiolabel escape for systemic circulation. with distant metastasis, including the gastrointestinal The surgical team chose for double venous return tract (TGI), in which case, the most common location is cannulation with femoral vein and saphenous vein at small bowel. The symptomatology is indolent, with in the circuit. Perfusion of the limb with Melphalan nonspecific abdominal pain and anemia. The most heated at 41.5 degrees for 60 minutes. The patient common complications are bleeding, obstruction, had a good evolution, being discharged on the third perforation and intestinal intussusception. In cases postoperative day (POD). He returned at 14th POD of complications, surgical treatment is indicated and with necrosis and apparent complete remission of should preferably involve resection of the metastatic limb disease. Discussion: A challenge for physicians lesion. Uncomplicated visceral metastasis are treated and patients is advanced locoregional melanoma, systemically, except when TGI is the only site of which often does not respond to conventional metastasis, and complete resection of the lesions chemotherapy treatment and has high relapse rates. is possible. Final Comments: TGI is a common site In the case presented, we detail the approach of a of metastasis in cases of disseminated melanoma. patient with advanced left lower limb locoregional Autopsy studies revealed an incidence of about disease by the IMP method. This procedure consists 60% of intestinal metastasis in patients who died of of the use of high-dose chemotherapy on the disseminated melanoma, but in clinical practice about affected limb, avoiding systemic circulation and its 5% of patients with disseminated disease have this harmful effects. However, as described here, the type of lesion. Establishing preoperative diagnosis surgeon may face unexpected situations during the of small bowel metastasis is difficult due to the non- perioperative period, especially vascular changes specificity of symptoms and limitations of diagnostic that require adaptability. Conclusion: Treatment methods. The definitive diagnosis is obtained after of locally advanced melanoma is complex and surgical exploration and resection of the lesion. With challenging. Besides the use of immunotherapy the present report we emphasize that melanoma and target therapy in the adjuvant and palliative patients with persistent gastrointestinal complaints scenario, Isolated Limb Perfusion remains a or acute abdomen should have as a clinical suspicion therapeutic option for selected cases, presenting gastrointestinal metastasis, so the necessary satisfactory results when performed by experienced propaedeutics is established and the appropriate and qualified surgical team to manage intraoperative cancer treatment performed. complications
Contato: Fernanda Alonso Rodriguez Fleming Contato: Alberto Julius Alves Wainstein [email protected] [email protected]
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TEMÁRIO: ONCOLOGIA CUTÂNEA Júnior / Silva Júnior, L. L. / Liga Norte Riograndense Contra CÓDIGO: 88355 o Câncer; Ronnie Peterson de Melo Lima / Lima, R. P. M. / Liga Norte Riograndense Contra o Câncer; Laura Cristina LATE MELANOMA GASTRIC METASTASIS Costa e Silva / Silva, L. C. C. / Universidade Potiguar; Ana Luísa da Silva Maia / Maia, A. L. S. / Liga Norte Riograndense Autores: Max Wellington Satiro Justino / Satiro, M. W. J. / Contra o Câncer; José Américo dos Santos Costa Neto / Hospital de amor de barretos; Gabriel da Rocha Bonatto Costa Neto, J. A. S. / Liga Norte Riograndense Contra o / Bonatto, G. R. / Hospital de amor de barretos; Carlos Câncer; Rosane Nayara de Medeiros Alves Fernandes / Eduardo Barbosa Carvalho / Carvalho, C. E. B. / Hospital Fernandes, R. N. M. A. / Universidade Potiguar; Crislanny de amor de barretos; Paulo Victor Fortes Sampaio / Regina Santos da Silva / Silva, C. R. S. / FAMENE; Ana Clara Sampaio, P. V. F. / Hospital de amor de barretos. da Silva Maia / Maia, A. C. S. / Universidade Potiguar.
Case Presentation: Female patient, 69, hypertensive Case Presentation: F.P.O., male, 72-years-old, referred to and dyslipidemic, with a history of previous surgery for urology service complaining of mass in the right testis (RT) melanoma resection on left popliteal fossae 30 years for three months, measuring 2.7 x 2.2 cm by ultrasound. ago, presenting for two years a clinical status of asthenia, Tumor-specific markers for testis AFP, LDH and hCG were adynamia and anemia. Investigation was performed with requested, all negative results. The patient underwent right high digestive endoscopy; ulcerous-infiltrative lesion was unilateral radical orchiectomy. Pathology (PA) revealed identified with ulcerated and necrotic bottom, within the malignant neoplasm of epithelioid cells suggestive of RT great curvature and medio-distal body, with an extension metastatic melanoma, measuring 4.5 cm, with large areas to anterior e posterior walls, Borrmann III. The histo- of necrosis, free margins, and immunohistochemistry pathologic results showed malignant neoplasia poorly confirmed secondary involvement by melanoma. Upon differentiated by pigments on cytoplasm of atypical return, there were suspicious malignant skin lesions on the cells compatible with metastatic melanoma. A systemic back, nasal dorsum and medial face of the left arm, and the treatment was conducted with Vemurafenibe without any patient referred to the surgical oncology. Then, performed response. Hence, surgery had been chosen. Patient was exeresis of skin lesions with margins of 2 cm. The PA submitted to a full gastrectomy with lynphadenectomy D2 revealed, on the back, extensive superficial melanoma with and Y-de-Roux reconstruction. With an anatomopathologic vertical growth, absent ulceration, Clark level IV, Breslow of metastatic melanoma, measuring 12.5 x 11.8cm, 2.7 mm. Lesions on the nasal dorsum and medial face of surgical margins and lymph nodes free of neoplasia. the left arm were compatible with melanoma implants. Patient follows as outpatient for two years with clinical Abdominal computerized tomography found numerous and complementary exams, without signs of receding or hepatic nodules suspicious of secondary involvement. localized disease. Discussion: The digestive tract is not a In cranial magnetic resonance imaging, were observed common place for melanoma metastasis, being the small spontaneous T1-juxtacortical hyper signal foci involving intestines the most frequently affected. Gastric metastasis left temporal lobe, bilateral frontal lobes and right is found only in 7% of the cases, however, clinically, the parietal lobes compatible with secondary involvement. diagnostic rates are only of 2.3%, generally found years Chemotherapy with Dacarbazine and cranial radiotherapy after the initial disease. Gastric metastasis may begin 30 Gy were started. Currently, under clinical follow-up. through direct invasion, mostly from neoplasia of distant Discussion: Melanoma is a malignant melanocytic tumor tumors. Patients with metastasis to the gastrointestinal of preferential cutaneous origin, with high metastatic tract may present symptoms such as abdominal pain, potential. The main sites of metastasis include the dysphasia, obstruction of small intestines, diarrhea, central nervous system, liver and lung, and the testicular hematemesis and melena, but are frequently unspecific, involvement is a rare event little addressed in the literature. and the indication to perform digestive endoscopy, It is even more unusual when the diagnosis of cutaneous it usually is a chronic anemia by iron deficiency. Final melanoma is made by such metastasis, simulating primary remarks: Melanomas gastric metastasis may present itself testicular neoplasm. Melanocytic testicular metastasis is with darkened pigmented ulcers, dark diffuse pigments often underdiagnosed and only identified in therapeutic on the mucosa, multiple small nodules on mucosa or autopsies or orchiectomies. Due to the presentation of the subserosal, polyploidy lesions or extrinsic masses. These disease in advanced cases, it has a poor prognosis. Final lesions are frequently pigmented though they may present considerations:Given this case, melanocytic metastasis themselves in a non-pigmented form, mimicking other should be used in the differential diagnosis of testis tumors. epithelial neoplasia and MALT lymphoma. Therefore, Also, be careful to do clinical research for suspected lesions biopsies are mandatory in patients with a history of whenever relevant by the doctor, providing to the patient melanoma submitted to endoscopy, even if lesions are the chance of early diagnosis and appropriate therapeutic not pigmented. institution, favoring a better prognosis of the disease.
Contato: Gabriel da Rocha Bonatto Contato: André Luiz Costa e Silva [email protected] [email protected]
TEMÁRIO: ONCOLOGIA CUTÂNEA TEMÁRIO: ONCOLOGIA CUTÂNEA CÓDIGO: 87921 CÓDIGO: 87699
MALIGNANT MELANOMA REVEALED BY MELANOMA AND BREAST CANCER: CASE TESTICULAR METASTASIS REPORT Autores: André Luiz Costa e Silva / Silva, A. L. C. / Liga Autores: Mariana Gregorio / Gregorio, M. / Universidade Norte Riograndense Contra o Câncer; Luciano Luiz da Silva Federal da Fronteira Sul; Letícia Signori Kohl / Kohl, L. S /
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Universidade Federal da Fronteira Sul; ícaro de Azevedo Autores: Daniel de Paula Santana / SANTANA, D. P. / Alexandre / Alexandre, I. A. / Universidade Federal da HOSPITAL ARAÚJO JORGE ; Bruna Xavier Rezende / Fronteira Sul; Renata Bruna Garcia dos Santos Gatelli / REZENDE, B. X. / HOSPITAL ARAÚJO JORGE. Gatelli, R. B. G. S. / Hospital de Clínicas de Passo Fundo; Charles Nilton Gatelli / Gatelli, C. N. / Hospital de Clínicas Introdução: Melanoma é o câncer de pele mais agressivo, de Passo Fundo; Fernanda Pinho Tagliari / Tagliari, F. cuja incidência vem aumentando, e é atualmente o P. / Universidade de Passo Fundo; Nathalia Rochinhas quinto câncer mais comum em homens e o sexto mais da Costa Portella / Portella, N. R. C. / Universidade de comum em mulheres nos Estados Unidos. O melanoma Passo Fundo; Naura Danieli Marcon / Marcon, N. D. / não é incomum na gravidez, com uma taxa de ocorrência Universidade de Passo Fundo; Mônica Linhares Sachett estimada em 1:1.000. O melanoma é o câncer com maior / Sanchett, M. L. / Universidade Federal da Fronteira Sul. incidência de metástases para placenta e feto, apesar de não ser o mais comum na gestação. Métodos: Os L.S.G., female, 40 years old, in 2007 reports a black, presentes casos foram diagnosticados e tratados em scaly, warty and irregular lesion, with itching and dois centros de referência em oncologia em Goiânia, sporadic bleeding, in the left calf that showed gradual Goiás, Brasil e a relevância baseia-se nas controvérsias growth. Excision biopsy and sentinel lymph node were em relação ao tratamento e prognóstico do melanoma performed, which were positive for melanoma. After na gestação. Resultados: CASO 1: 29 anos, 12 semanas lymphadenectomy, the patient was followed up for de gestação, G2P1A0, fototipo IV com história de lesão 4 years without chemotherapy. In 2012, there were pigmentada em região dorsal há 10 anos, com prurido, 4 nodules in the left knee with positivity for tumor aumento e alteração do relevo, com 2,5x1,8cm. Biopsia metastasis, underwent chemotherapy with Interferon. excisional com diagnóstico de melanoma extensivo Two years later, a screening mammogram found superficial, Breslow 0.7 mm, IM=0/mm², ulceração suspicious nodules. Puncture determined infiltrating ausente. CASO 2: 29 anos, 32 semanas de gestação, right breast carcinoma. Right mastectomy was performed G1P0A0, fototipo III, com lesão pigmentada plantar without adjuvant chemotherapy. In 2018, he referred direita há 6 anos, com aumento e alteração do relevo, mass emergence in the medial and proximal region of com 1,8X1,0cm. Biópsia excisional com diagnóstico de the left thigh of continuous growth, evolving to injury melanoma acrolentiginoso, Breslow 2.1 mm, IM = 0/ with bleeding and pain. Respectively, since January 2019, mm², ulceração ausente. Conclusão: CASO 1: submetida he has had diplopia and pain in the lumbar and iliac a ampliação das margens na 20ª semana de gestação. regions. As a family history, she had a mother with basal O histopatológico revelou ausência de doença residual. cell carcinoma in situ at the age of 66 and her paternal O histopatológico da placenta e seus anexos mostrou- grandfather died of lung cancer and had leukemia. Patient se sem alterações. Em acompanhamento periódico. underwent magnetic resonance imaging of the cervical CASO 2: submetida a ampliação das margens e biopsia spine, which showed nodular lesions in the vertebral do linfonodo sentinela inguinal, após o parto. Histologia bodies and degenerative discopathy. Secondary exams sem evidência de doença residual e linfonodo negativo. showed right pleural effusion and metastases in the liver, Não foi realizado exame da placenta. Em seguimento lumbar spine, right eye and pelvis. Patient underwent left periódico. Cerca de 30 a 35% das mulheres com thigh mass excision, biopsy and immunohistochemistry melanoma estão em idade fértil no momento do confirmed melanoma metastasis. Skin cancer accounts diagnóstico. Durante anos, foi amplamente aceito for 33% of all cancer diagnoses in Brazil. Melanoma is que o prognóstico do melanoma era pior na gravidez a type of malignant skin cancer, aggressive, lethal, and e que as gestações subsequentes aumentam o risco with poor prognosis, not being the most frequent. In de recorrência. No entanto, a literatura científica atual general, the lesions are of a practical diagnosis and defende que prognóstico, recorrência e incidência do have more than 90% cure if evaluated early. Metastatic melanoma parecem não ser afetados pela gravidez. O melanoma is rarely curable; however, there are palliative tratamento do estágio inicial do melanoma é o mesmo, measures that support the patient. Approximately two independentemente da gestação. Linfocintilografia thirds of the initial metastases are limited to the regional pré-operatória e biópsia do linfonodo sentinela podem lymph node drainage area. Melanoma, as a malignant ser realizadas com segurança em gestantes. Por fim, skin tumor, aggressive and of major incidence, especially ressaltamos que a conduta na paciente gestante com in southern Brazil, raises the need for continuous and melanoma não difere dos demais pacientes, embora incisive awareness of the population. In addition, one o tratamento do melanoma possa ser adiado se a must always see the patient affected by the disease as paciente estiver próxima do parto, como no caso 2. a whole, not ruling out the possibility of new primary tumors of another strain or metastases, which should Contato: Daniel de Paula Santana have their site of origin investigated. [email protected]
Contato: Mariana Gregorio [email protected] TEMÁRIO: ONCOLOGIA CUTÂNEA CÓDIGO: 87149
TEMÁRIO: ONCOLOGIA CUTÂNEA MELANOMA METASTÁTICO TRATADO CÓDIGO: 88132 COM IMUNOTERAPIA E AS REAÇÕES IMUNOMEDIADAS MELANOMA CUTÂNEO EM PACIENTES ADULTO JOVENS GRÁVIDAS: RELATO DE 2 Autores: Jandra Evangelista / Evangelista, J. / Hospital CASOS Araújo Jorge; Ricardo Restivo de Castro Teixeira / Restivo, R.C.T. / Hospital Araújo Jorge; Luísa Oliveira Lemos /
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Lemos, L.O. / Puc Goiás; Danilo Gusmão / Gusmão, D. da Silva Fontinele / Fontinele, D. R. S / Universidade / Hospital Araújo Jorge; Mayza Lemes Duarte / Duarte, Estadual do Piauí; Edimar Duarte Val / Val, E. D. / L.M. / Hospital Araújo Jorge; Hospital São Marcos; Sabas Carlos Vieira / Vieira, S. C. / Oncocenter; Caio Alcobaça Marcondes / Marcondes, C. Apresentação do caso: Em julho de 2017, paciente A. / Hospital São Marcos. masculino, 63 anos, queixa de lesão hiperpigmentada em planta do pé esquerdo há 3 anos de aumento Case Presentation: 49-year-old female patient, progressivo. Clinicamente, observou-se lesão de 4 x 2,5 navigator aircraft . Five years ago, he presented a large cm, ausência de área de regressão e pequena ulceração soft tissue tumor on the wall pelvic area at the level of local. Em agosto de 2017, foi submetido à ressecção da the pubic region, fixed to the deep planes. The magnetic lesão primária em pé esquerdo e esvaziamento inguinal resonance revealed extensive multiloculated solid- esquerdo. O exame anatomopatológico de pele sugeriu cystic lesion affecting the anterior wall of the lower melanoma maligno acral lentiginoso. Foram encontradas abdomen compromising the subcutaneous and closely metástases de melanoma para 4 linfonodos inguinais. Os related to posterior aponeurosis measuring 13.8 x12.8 exames de estadiamento indicavam doença metastática x 10.3 cm, a large tumor resection was performed. The pulmonar e hepática. O tratamento teve inicio no final histopathological revealed a multicystic epithelioid de agosto de 2017 com Nivolumabe 3mg/kg. Em outubro neoplasia and the immunohistochemistry confirmed de 2018, manifestou lesões bolhosas infectadas na face Multicystic peritoneal mesothelioma. After 2 years medial da coxa esquerda. A hipótese estabelecida foi de presented solid nodules in the pelvic abdominal wall, with reação imunomediada, com prescrição de Prednisona neoplastic features and hernia and biopsy of the lesion 60mg e suspensão do Nivolumabe. Em dezembro de with histopathology. After 2 more years, and without 2018, houve o desmame corticoide dado a melhora performing a biopsy of the lesion, he had a large soft das lesões e foi proposto retorno da imunoterapia. Em tissue tumor in the pelvic wall and recurrent pubic region. fevereiro de 2019 apresentou nova reação cutânea Pelvic tomography with multiple cystic, clustered anterior grau IV. O Nivolumabe foi suspenso por tempo abdominal region measuring 20 x 9 cm predominantly indeterminado. Ao exame anatomopatológico da pele, at the extending to the inguinal region and right thigh foram identificadas alterações que sugeriram dermatite measuring 19 x 20 cm. Comprehensive tumor resection vesiculosa sub-epidérmica contendo eosinófilos, with rotation reconstruction with multiple myocutaneous sendo assim estabelecido o diagnóstico de penfigóide flaps in the abdomen region, flanks, flaps ofright bolhoso secundário à imunoterapia. Discussão: O and left thigh and vulva flap. The resection product melanoma acrolentiginoso (MAL) corresponde a 5% de weighed 4832g, with the following dimensions 32.0 x todos os melanomas, sendo o subtipo mais agressivo e 21.0 x 14.0cm. Patient presented flap necrosis in the raramente encontrado em fases in situ. A imunoterapia postoperative period, with healing by second intention. é uma das opções de tratamento, porém seu uso pode Follow for 9 months with complete healing, no relapse apresentar efeitos adversos cutâneos, gastrointestinais, and no complaints. Discussion: It is a rare cyst syndrome hepáticos, renais, endócrinos e pulmonares. A incidência recurrent peritoneal mesothelial. Reaches women more de efeitos colaterais de qualquer grau frente o uso de than men in their younger years. Magnetic resonance is imunoterapia com anti PD1, como Nivolumabe, usado no there search of choice. The main management is surgical caso apresentado, varia de 60 a 75%. Possuem resolução resection. However, the recurrence rate is estimated se adequadamente manejados, podendo, entretanto, to be up to 50%. The transformation malignant is rare. ocorrer mesmo após descontinuação do tratamento. Survival is prolonged despite bulky disease. In addition, Dentre as reações cutâneas, as principais são o prurido, no deaths have been attributed to this disease. Final erupção cutânea maculopapular e vitiligo. Comentários comments: A the neoplasm in question is rare, especially finais: Ainda que usualmente manejáveis e reversíveis, in the dimensions presented here. It is important that os efeitos adversos imunomediados podem resultar diagnosis and treatment are not delayed. The surgeon em disfunção permanente ou mesmo óbito, sendo and the plastic surgeon should discuss and plan these essencial a estruturação de equipes multidisciplinares, cases. Also, watch out for relapses. bem como a incorporação de diretrizes para o manejo eficaz e o reconhecimento e diagnóstico precoces, com Contato: Iran Batista de Brito eficaz introdução de terapêutica dirigida. Dessa forma, é [email protected] possível o uso seguro e adequado dessa modalidade de tratamento em expansão. TEMÁRIO: ONCOLOGIA CUTÂNEA Contato: Ricardo Restivo de Castro Teixeira CÓDIGO: 87686 [email protected] PRIMARY NONCUTANEOUS MELANOMA OF THE BREAST: CASE REPORT AND LITERATURE TEMÁRIO: ONCOLOGIA CUTÂNEA CÓDIGO: 87985 REVIEW Autores: Eduardo Doria Filho / Doria-Filho, E / Clínica MULTICYSTIC EPITHELIAL MESOTHELIOMA AMO; Aléssio Brunn / Brunn, G. A. R. / Clínica AMO; INFILTING WALL ABDOMINAL AND THIGH: Rafael Ribeiro / Ribeiro, R. S. / Clínica AMO; Adriano CASE REPORT Carvalho / Carvalho, A. M. P. F. / Clínica AMO; Nathanael Pinheiro / Pinheiro, N. F. / IMAGEPAT; Rodrigo Guedes Autores: Iran Batista de Brito / Brito, I. B. / Hospital / Guedes, R. A. V. / Clínica AMO; Miguel Brandão / São Marcos; Ana Caroline da Fonseca Soares Pereira / Brandão, M. A. R. / Clínica AMO. Pereira, A. C. F. S / Hospital São Marcos; Danilo Rafael
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- Case Report: A 44-year-old woman presented of in situ melanoma of lentiginous pattern by incisional with a progressive growth lesion on the right breast biopsy. The lesion diameters were approximately in the last 6 months. Initial core biopsy suggesting 45x35mm, located in the left calcanea region, two years poor differentiated malignant round cells tumor evolution and fast growth in the last two mounths. The with immunohistochemistry confirming melanoma region was blackened, asymmetrical and with irregular diagnosis. Submitted to radical modified right edges. Surgical treatment was performed with resection mastectomy with final pathological report describing a of the lesion, with a 10mm margin, and reconstruction 10 x 9 x 7 cm size melanoma tumor, surgical margins with the reverse flow sural fasciomyocutaneous free of neoplasia, extensive angiolymphatic invasion flap technique. The histopathological of the lesion and presence of 7 mitoses per 1 mm2. The nipple resected, confirmed the diagnosis of melanoma in situ was infiltrated by melanoma however the dermis and of acral lentiginous pattern, in radial growth phase, epidermis were not involved. Eighteen axillary lymph Clarks level I infiltration, mitotic activity not detected, nodes were also evaluated, 15 of them had melanoma peritumoral lymphocyte infiltration scarce, regression involvement with 1 presenting capsular leakage. - areas absent, microscopic satelitosis and ulceration Discussion: Breast melanomas can be divided into three not detected. Discussion: The surgical treatment of the majors clinical manifestations: cutaneous melanoma acral melanoma represents a challenge to the surgeon, overlying the skin of the breast; metastatic melanoma seeking the total resection of the lesion, with the goal of in the breast and primary noncutaneous melanoma of healing and prevent the relapses. In the Acral lentiginous the breast (PNMB), the most rare subtype. PNMB has a melanoma its recommended the complete excision poorly described clinical presentation with only a few of the lesion, with margin in agreement with Breslows previous case reports on the literature. Little is known thickness, however, doenst apply to the case in question, about the therapeutic and prognostic management because it is a melanoma in situ. The proper resection of this condition. The age of diagnosis in the previous of the melanoma in the palm region or the plantar studies was 26-76 years old, mastectomy surgery with usually produce skin defects that cant be remodel with axillary dissection (sentinel lymph node biopsy or primary suture. When the incision hits places tha dont complete node dissection) was the standard approach suffer from body weight, such as the plantar arch, the and only one previous report presented tumor size skin graft usully provides an adequate cover. However, larger than 5 cm, which was the case of this study. in a surfece that sustain the body weight, like the - Final comments: Extremely rare presentation of calcanea, the skin graft sometimes dont present a good melanoma with primary site in the breast parenchyma, cicatrization. The reverse flow sural flap consists in the material reviewed by an experienced pathologist and dissection of the fasciomyocutaneous tissue, between subjected to immunohistochemistry, with only 7 similar the medial and lateral portions of the gastrocnemius case reports described in the international literature. muscle, with a wide rotacional arch that varies between 90º-180º and present a axial pattern based on reverse Contato: Eduardo Doria Filho arterial flow of the superficial sural artery branch of [email protected] the fibular artery. Final comments: The surgery in the treatment of the acral lentiginuos melanoma, can be a challenge, to come across large areas for resection TEMÁRIO: ONCOLOGIA CUTÂNEA making it impossible a full reconstruction. The reverse CÓDIGO: 87692 flow sural flap turned out to be a valuable technique to the reconstruction of the resected areas, mostly in the RESECTION OF ACRAL LENTIGINOUS regions that endure weight favoring cicatrization. MELANOMA WITH REVERSE FLOW SURAL Contato: Paulo Henrique Ribeiro de Oliveira FLAP RECONSTRUCTION [email protected] Autores: Paulo Henrique Ribeiro de Oliveira / Oliveira,P.H.R. / Hospital Escola Álavo Alvim; Pedro Augusto Corrêa de Araújo Rodrigues Caldas / TEMÁRIO: ONCOLOGIA CUTÂNEA Caldas,P.A.C.A.R. / Hospital Escola Álvaro Alvim; Paola de CÓDIGO: 87171 Araujo Sardenberg Alves / Alves,P.A.S. / Hospital Escola Álvaro Alvim; Kelli da Silva Gonçalves / Gonçalves,K.S. / RETROABDOMINAL HIBERNOMA: CASE Hospital Escola Álvaro Alvim; Lara Rodrigues Moreira / REPORT Moreira,L.R. / Hospital Escola Álvaro Alvim; Livia Nunes Barboza Duarte / Duarte,L.N.B. / Hospital Escola Álvaro Autores: Pâmela Goretti Guedes / Guedes, P.G. / Santa Alvim; Barbara Paula dos Santos Batista / Batista,B.P.S. Casa de Misericórdia de Juiz de fora-MG; Ana Leda / Universidade Federal Fluminense; Maria Teresa Castellano Ranção / Ranção, A.L.C. / Santa Casa de Fernandes Pessanha / Pessanha,M.T.F. / Hospital Misericórdia de Juiz de Fora-MG; Glaucio Silva de Souza Escola Álvaro Alvim; Meire Cardoso da Mota Bastos / / Souza, S.G / Santa Casa de Misericórdia de Juiz de Bastos,M.C.M. / Hospital Escola Álvaro Alvim; Haroldo Fora-MG; Gabriel Victor Dornelas / Dornelas, G.V / Santa José Siqueira da Igreja Junior / Junior,H.J.S.I. / Hospital Casa de Misericórdia de Juiz de Fora-MG; Bruno Moreira Escola Álvaro Alvim. Portes / Portes, B.M / Santa Casa de Misericórdia de Juiz de Fora-MG; Lucas Quinet de Andrade Bastos / Bastos, Case Presentation: Pacient female, 44 years old, L.Q.A / Santa Casa de Misericórdia de Juiz de Fora-MG. Fitzpatricks phototype V, no personal or family history of melanoma. Referred to the oncologic surgery Case Report: A woman aged 20, without comorbidity, department, because of the diagnosis of histopathology maternal history of breast cancer. She comes to see
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to doctor complaining about claudication and edema done the reconstruction. The lesions dimensions was on her left leg, related to her ipisilateral pelvic area. It 23,5x23x2,8cm. The histopatological study identified refers to a fast tumor growth in six months, in the same multiples points of growing lesions, with sizes from area which another nodule was previously resected. Six 0,1 to 2,1cm, reaching the hypodermis, with a variable months ago, a nodule was resected in the area of the polymorphism and even 6 mitoses by 10 high rise current lesion. It has been done an abdomen superior fields, without angiolymphatic invasion. Discussion: and pelvis TC and RM, that have shown a bulky definite The angiosarcoma is a rare entity, secundary to large formation, containing mainly fat, bordered by vascular endothelial cells and with a bed prognosis an abdominal wall and iliac psoas muscles, displacing due its frequents local relapses. This disease usually medially the iliac vessels, measuring about 9,4 x 5,1 x affect the lymphatic paths and is the most common 12,5 cm. The lesion was resected, showing a satisfactory head and neck sarcoma to have this kind of spread. evolution during post surgery period. Histopathological Final comments: in agreement with the literature, our and imuno-histochemistry characterizing adipocytic patient presented the most outstanding features of this neoplasia, typical of hibernoma. It was not indicated disease: old male and mutifocal lesions, although has a complementary treatment. It was signed a written no history of radiation. Our patient didnt presented clarification form, authorizing the case publication. lymph nodes with disease, contradicting the tendency Discussion: the hibernoma is an uncommon tumor of lymphatic spread. Due to aggressiveness of this kind originated from brown fat, benign, hypervascularized, of tumor and the risk factors presented, the close follow with high a high recurrence rate and low metatastic up of this patient is need. potencial. The occurrence is common mainly in men, in their thirties. Clinically, the hibernoma Contato: Ágata Rothert consists of painless mass, movable, with a slow [email protected] growth, symptomatic when compressing adjacent structures. The diagnosis is made by histopathology and immunohistochemistry after surgical excision. TEMÁRIO: ONCOLOGIA CUTÂNEA Histologically it is mostly constituted by brown and CÓDIGO: 87458 yellow adipocytes. In imaging examinations, the main differential diagnosis is lipoma and liposarcoma due SENTINEL LYMPH NODE RESEARCH IN THE to their content similarity. The treatment consists on MERKEL CELL CARCINOMA: CASE REPORT the excision of the lesion, with free resection margins, and the chance of recurrence can be higher in case of AND LITERATURE REVIEW incomplete excision of the tumor. Despite being an Autores: Manuella Caroline Dutra Frazão Alves / FRAZÃO uncommon pathology it presents a good prognosis due ALVES, M. C. D. / Universidade Federal do Estado do to its benignity. Final comments: The hibernoma is an Rio de Janeiro - UNIRIO; Beatriz Escudeiro Nascimento uncommon benign neoplasia, classified as lipomas. Its / NASCIMENTO, B.E. / Universidade Federal do Estado diagnosis is histological and immunohistochemical. The do Rio de Janeiro - UNIRIO; Carlos Eduardo Belarmino therapeutic approach is surgical. The case significance Filho / BELARMINO FILHO, C. E. / Universidade Federal can be attributed to the fact that this neoplasia is do Estado do Rio de Janeiro - UNIRIO; Daniele Rodrigues extremely rare and it is seldom correctly diagnosed, Neves da Costa / COSTA, D. R. N. / Universidade Federal because of the real fine line among other differential do Estado do Rio de Janeiro - UNIRIO; Gabrielly Saraiva diagnoses. Porto Garcia / Garcia, G. S. P / Universidade Federal do Estado do Rio de Janeiro - UNIRIO; Laura Pereira Contato: Pâmela Goretti Guedes Guimarães / Guimarães, L. P. / Universidade Federal [email protected] do Estado do Rio de Janeiro - UNIRIO; Leonardo Cruz Gomes / GOMES, L. C. / Universidade Federal do Estado do Rio de Janeiro - UNIRIO; Vanessa Veronica Brocki TEMÁRIO: ONCOLOGIA CUTÂNEA Oliveira / BROCKI, V. V. O / Universidade Federal do CÓDIGO: 88166 Estado do Rio de Janeiro - UNIRIO; Antonio Felipe Santa Maria Coquillard Ayres / Santa-Maria AF / Universidade SCALP MULTIFOCAL ANGIOSARCOMA: A Federal do Estado do Rio de Janeiro - UNIRIO; CASE REPORT C.R. 70 years old, male, white, with advanced Autores: ágata Rothert / Rothert, A. / Hospital São Parkinson‘s Syndrome, reports onset of violaceous Vicente; Priscila Nunes Silva Morosini / Morosini, P. N. macula and pruritus in progressive growing left wrist S. / Hospital São Vicente; ágata Rothert / Rothert, A. for 3 months, associated with ulceration and jet tumor / Hospital São Vicente; Juliano Rebolho / Rebolho, J. / bleeding. On physical examination, a 9 cm sarcomatoid Hospital São Vicente; Débora Mattana Vasconcelos tumor, hemorrhage, and limiting edema of the hand Teixeira / Teixeira, D. M. V. / Hospital São Vicente; were observed. There were no signs of lymph node Marcela Santos Cavalcanti / Cavalcanti, M. S. / Hospital enlargement. Initial staging showed no signs of São Vicente; systemic spread and no left axillary adenomegaly was evidenced. Upper limb CT reveals tumor occupying Presentation: D.Z., male, 73 years, prevously healthy, half of wrist circumference, touching bone plane. presented suddenly a bulky mass in occipital portion Lymphoscintigraphy for Sentinel Lymph Node Research with fast growing. The lesion was removed and the (PLS) reveals radiocaptant area in the left axilla. bed of lesion was left bloddy, so in a second look with The surgical procedure started with sentinel node de confirmation of free lesions borders, would be biopsy, being positive for neoplasia. Wrist amputation
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associated with axillary lymphadenectomy was to 2014. The age ranged from 19 to 87 years, with a performed. Patient had no postoperative complications slight predominance in females (53.6%). The most and was discharged 7 days after axillary drainage volume frequent location of the trunk and melanoma is most reduction. Histopathological analysis of the surgical lesions mediates between 0.5cm and 1.0cm. The most specimen revealed Merkel Cell Carcinoma with sentinel common histopathological classification was melanoma lymph node macrometastasis, stage T4N1bM0, stage superficial at 62.6% and the average Breslow 2.3mm. IIIb, and was referred for adjuvant radiotherapy. This The largest number of sentinel lymph nodes were found paper aims to discuss a case of Merkel cell carcinoma, in the axillary and inguinal regions. One sentinel node in which PLS changed the proposed treatment, was resected in 38.6% of patients and seven (3.4%) had changing the patient‘s staging and allowing a more five lymph nodes resected. The sentinel lymph node specific approach to axillary lymphadenectomy and biopsy was performed in day hospital basis, under radiotherapy, in addition to defining a more reserved intravenous sedation and local anesthesia costs 17% case prognosis. . This technique consists in the detection lower compared to hospitalization. Positivity found the and histopathological study of the first lymph node to pathology and / or immunohistochemical sentinel node receive lymphatic drainage of a given tumor. Based on was 22.74%. Among the positive, only four patients did this assessment, staging is more accurate for lymphatic not undergo the procedure, due to advanced age or spread. The importance of this information is the best rejection of the possibility of partial loss of upper limb determination of the prognosis and treatment to be functionality. The melanoma recurrence occurred in recommended. This technique is widespread in diseases 15.4% of patients, the prime suspect method of clinical such as breast cancer, vulval cancer and melanoma, but examination. The 10-year survival for the disease in has not been properly studied in the context of Merkel stage I was 89% for stage III and 36%. Conclusion: The cell carcinoma, probably because it is a rare neoplasm. biopsy of sentinel lymph node has an important role in Thus, we emphasize that PLS was clinically important in the treatment and staging of patients with melanoma. the case presented because it improves the accuracy The technique is possible in day hospital character and of nodal staging, and consequently changes the final low morbidity. surgical treatment. As this is a case report there are no definitive conclusions about the relevance of PLS, nor Contato: Alberto Julius Alves Wainstein the impact that early lymphadenectomy can have on [email protected] these individuals, however there is room for further studies in this regard. TEMÁRIO: ONCOLOGIA CUTÂNEA Contato: Manuella Caroline Dutra Frazão Alves CÓDIGO: 88209 [email protected] SURGICAL APPROACH MAY BENEFIT POSITIVE SENTINEL NODE MELANOMA PATIENTS TEMÁRIO: ONCOLOGIA CUTÂNEA CÓDIGO: 88242 AFTER RELAPSE Autores: Matheus de Melo Lôbo / Lôbo, MM / AC SENTINEL NODE BIOPSY ASSESSEMENT IN CAMARGO CANCER CENTER; Dante Arra / ARRA, DASM PATIENTS WITH MELANOMA - ANALYSIS OF / AC CAMARGO CANCER CENTER; Jacqueline Nunes 211 CASES Menezes / MENEZES, JN / AC CAMARGO CANCER CENTER; Vinicius Fernando Calsavara / CALSAVARA, VF Autores: Milhem J M Kansaon / Kansaon, M.J.M. / Oncad; / AC CAMARGO CANCER CENTER; Clóvis Antonio Lopes Ana Paula Drummond-lage / Drummond-Lage, A.P. / Pinto / PINTO, CAL / AC CAMARGO CANCER CENTER; Faculdade Ciências Médicas de Minas Gerais; Everton Eduardo Bertolli / BERTOLLI, E / AC CAMARGO CANCER Ferrão / Ferrão, E. / Oncad; Otto Muller / Muller, O. / CENTER; João Pedreira Duprat Neto / DUPRAT NETO, JP Oncad; Guilherme Souza / Souza, G. / Oncad; Alberto / AC CAMARGO CANCER CENTER; Julius Alves Wainstein / Wainstein, A.J.A. / Faculdade Ciências Médicas de Minas Gerais; Clinical evolution of stage III melanoma patients can be unpredictable, since high recurrence and mortality Introduction: Melanoma is a public health problem rates occur, which makes treating these patients because it is an aggressive cancer with early challenging. The actual role of surgical treatment after dissemination capacity. The staging andt he involvement relapse remains unclear and the goal of this study of lymph nodes has great importance in the treatment is to evaluate the impact of surgery in this scenario. and prognosis. Objectives: Evaluate clinical data, Retrospective analysis of a single institution cohort of operative results, pathological findings and follow-up of melanoma patients with positive sentinel lymph node patients with melanoma accompanied by the same team biopsy (SNB) during a period of 15 years. Between of oncologic surgery. Methods: Non-interventionist 2000 and 2015, 1023 patients underwent wide local retrospective study analyzed data records of patients excision and SNB, 246 positive and 242 underwent with melanoma who had indication for sentinel lymph completion lymph node dissection. Median recurrence- node biopsy from 2005 to 2014. All had the exam free survival was 69.73 months and median melanoma- lymphoscintigraphy with marking the SLN and medical specific survival was 81.2 months. One hundred and records containing pathological information from the seven patients (43.5%) recurred, of which 85 (79.43%) primary tumor, treatment and monitoring. Results: were evaluated and 77,2% of those were in a single site. The study sample consisted of 211 patients who under Skin and / or lymph nodes were site of 50,6% relapses, went biopsy of the sentinel lymph node between 2005 followed by lungs and viscera (21,2% each) and central
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nervous system ( 7,1%). The treatment of the first layer melanocytes, extensive pagetoid dissemination, relapse was surgery in 47,1% of the patients, followed and multinucleated and irregular cells. Even though by 41,2% of non-surgical treatment and 11,8% did not even more studies, consider that there is no prognostic receive further treatment. Statistical analysis showed difference between single and multiple primary benefit for the surgical approach [HR 0.52 (95% CI: melanoma and treatment is incisional biopsy for both 0.295-0.916); p = 0.024] when compared to the other and, according to the AP, surgical augmentation and groups. Although systemic treatment has a strong sentinel lymph node. It is appropriate as therapeutic rationale after relapse in melanoma patients, surgery decisions and prognostic estimates of the risk factors should also be considered. Our data supports that, required for each individual injury. Identifying patients when feasible, surgical management was statistically at high risk of primary injury may allow early diagnosis favorable compared to other modalities. and better outcomes.
Contato: Matheus de Melo Lôbo Contato: Mariana Gregorio [email protected] [email protected]
TEMÁRIO: ONCOLOGIA CUTÂNEA TEMÁRIO: ONCOLOGIA CUTÂNEA CÓDIGO: 87716 CÓDIGO: 87589
TWO PRIMARY MELANOMAS: CASE REPORT UNUSUAL SITES OF MALIGNO MELANOMA Autores: Mariana Gregorio / Gregorio, M. / Universidade METASTASIS: BILIARY AND ADRENAL Federal da Fronteira Sul; Letícia Signori Kohl / Kohl, L. S / VESICLES - CASE REPORT Universidade Federal da Fronteira Sul; ícaro de Azevedo Autores: Thiago Yamamoto Amaral / AMARAL, T.Y. / Alexandre / Alexandre, I. A. / Universidade Federal da Santa Casa de Misericórdia de Maceió; Filipe Augusto Fronteira Sul; Renata Bruna Garcia dos Santos Gatelli Porto Farias de Oliveira / OLIVEIRA, F.A.P.F / Santa Casa / Gatelli, R. B. G. S / Hospital de Clínicas de Passo de Misericórdia de Maceió; Aldo Vieira Barros / BARROS, Fundo; Charles Nilton Gatelli / Gatelli, C. N. / Hospital A.V. / Santa Casa de Misericórdia de Maceió; Frederico de Clínicas de Passo Fundo; Ana Paula Pompeo Vartha / Theobaldo Ramos Rocha / ROCHA, F.T.R / Santa Casa de Vartha, A. P. P / Universidade de Passo Fundo; Nathalia Misericórdia de Maceió; Amanda Lira dos Santos Leite Portella / Portella, N. / Universidade de Passo Fundo; / LEITE, A.L.S / Santa Casa de Misericórdia de Maceió; Victor Sanchez Sago / Sago, V. S. / Universidade de Diego Windson de Araújo Silvestre / SILVESTRE, D.W.A Passo Fundo. / Santa Casa de Misericórdia de Maceió; Tainá Santos Bezerra / BEERRA, T.S. / Santa Casa de Misericórdia Male patient, 56 years old, former smoker, has de Maceió; Alberson Maylson Ramos da Silva / SILVA, pathological (AP), cervical lesion, removal in the city of A.M.R. / Santa Casa de Misericórdia de Maceió; Elson origin, type 4 nodular melanoma, Clark level, Breslow Alexandro Cordeiro Folha Filho / FILHO, E.A.C.F / Santa 4.6mm, loss of epidermal ulceration, microsatilitar and Casa de Misericórdia de Maceió; Gustavo Mendonça signs of regression. Presence of mild peritumoral, mild Ataide Gomes / GOMES, G.M.A.G / CESMAC. intratumoral lymphocyte reaction and 14 mitoses / mm2. Lesion 7mm from the nearest peripheral surgical Case Report: A 69-year-old female patient presented limit and 4.8mm from the deep. In addition, there was an with weight loss and palpable abdominal mass injury to the left upper limb. Performed an enlargement extending from epigastrium to right iliac fossa, with of the surgical wound margin (2cm) and sentinel pain that was difficult to control, as well as multiple lymph node cervical examination and left upper limb blackened skin lesions on the back. Chest / abdomen CT lesion excisional biopsy, whose AP shows extensive showed expansive gallbladder process, promoting intra superficial melanoma in the radial growth phase, Clark and extrahepatic bile duct dilatation, left adrenal tumor, level 2, Breslow 0.5mm, no epidermal ulceration and cystic liver lesions of uncertain nature, and multiple microsatellitus. Presence of regression focal area in pulmonary with secondary aspect. For the purpose of <75% of lesion and moderate peritumoral and mild histological diagnosis and symptom control, the patient intratumoral lymphocyte reaction. No identification of underwent exploratory laparotomy with findings angiolymphatic and perineural infiltration or mitotic of blackened gallbladder injury, 1st portion of the activity in the chemical component. Peripheral and duodenum, left adrenal topography and lymph nodes deep surgical limits free of neoplasms and lesions. in the celiac trunk. Cholecystectomy and biopsies of the Margin enlargement (1cm) was performed on the upper lesions were performed, in addition to resection of a left limb. The patient follows chemotherapy treatment blackened lesion on the back. Histopathological report with interferon. Synchronic melanomas are considered suggestive cutaneous melanoma in dorsal lesion and when a second lesion is seen at the first examination metastasis of gallbladder melanoma, celiac trunk lymph or within three months of the first diagnosis. A patient node and left adrenal mass. Discussion: Metastases diagnosed with primary melanoma has a 1.2 to 8.6% from cutaneous melanoma to the gallbladder and risk of developing a second primary melanoma. Of adrenal are uncommon and are usually asymptomatic. these, up to 30% are synchronous. The importance of Distant metastases usually affect the skin, lungs, liver discussing this type of involvement is to differentiate a and brain. According to autopsy results, asymptomatic new primary lesion from a metastasis, due to a different gallbladder metastases correspond to approximately approach between the two presentations. In addition 15% of cases. The role of surgical treatment of metastatic to clinical differentiation, or primary melanoma, gallbladder melanoma is still uncertain due to lack of characterized by exaggerated cell proliferation, granular
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experience in the subject. Therapy basically consists of defect and more than one stage for complete surgery. symptom palliation, minimization of complications and The disadvantages of this flap are that the pedicle, improving overall survival. Cholecystectomy may be which may be myocutaneous or myosubcutaneous, indicated in selected cases for pain control and in order is exposed for a few days postoperatively, the patient to achieve longer survival. Final considerations:The needs two surgical times to complete the procedure patient in question was submitted to laparotomy for and in men there may be a transfer of beard hair to pain control and also to document the abdominal the tip of the nasal wing. The nasogenian flap provides masses. The case is relevant due to few reports in the soft tissue thickness but does not provide the structural literature. part and nasal mucosa. The complications of using this flap are: postoperative bleeding, inadequate healing, Contato: Thiago Yamamoto Amaral infection, dehiscence, distortion of free margins and [email protected] necrosis.
Contato: Ignacio Salonia Goldmann TEMÁRIO: ONCOLOGIA CUTÂNEA [email protected] CÓDIGO: 87640
USE OF NASOGENIAN RETAIL IN FACIAL TEMÁRIO: ONCOMASTOLOGIA RECONSTRUCTION: CASE REPORT CÓDIGO: 87758 Autores: Ignacio Salonia Goldmann / Goldmann, I. S. BREAST CANCER WITH METASTASIS TO / Universidade Luterana do Brasil; João Maximiliano INGUINAL LYMH NODE Pedron Martins / Martins, J.M. P. / Hospital de Clínicas; Daniel Trahtman de Boer / Boer, D. T. / Universidade Autores: Renata Pereira Fontoura / Fontoura, R. P. / Luterana do Brasil; Lucas Pastori Steffen / Steffen, L. Liga Acadêmica de Oncologia do Hospital de Base do P. / Universidade Luterana do Brasil; Pedro Henrique Distrito Federal; Karine Viveiros Cardoso da Trindade Dallagnol / DallAgnol, P. H. / Universidade Luterana do / Trindade, K. V. C. / Liga Acadêmica de Oncologia do Brasil; Ane Caroline Araújo Barreto / Barreto, A. C. A. / Hospital de Base do Distrito Federal; Kétuny da Silva Universidade Luterana do Brasil; Anelise Agnes / Agnes, Oliveira / Oliveira, K. S. / Liga Acadêmica de Oncologia A. / Universidade Luterana do Brasil; Rafael Netto / do Hospital de Base do Distrito Federal; Erick Vinicius Netto, R. / Hospital Moinhos de Vento. Teixeira de Lima / Lima, E. V. T. / Liga Acadêmica de Oncologia do Hospital de Base do Distrito Federal; Introduction: The incidence of nonmelanoma skin Thaynara de Carvalho Ribeiro / Ribeiro, T. C. / Liga cancer is the most frequent and corresponds to more Acadêmica de Oncologia do Hospital de Base do than 30% of all malignant tumors in Brazil. Basal cell Distrito Federal; Amarildo Henrique da Conceição carcinoma arises in the cells of the basal layer of the Junior / Conceição Junior, A. H. / Liga Acadêmica de skin by intense sun exposure, being more frequent Oncologia do Hospital de Base do Distrito Federal; in exposed areas such as the face, scalp, neck, upper Sérgio Murilo Pereira da Silva Filho / Silva Filho, S. M. P. limbs, hands. Its treatment is the removal of the lesion / Liga Acadêmica de Oncologia do Hospital de Base do with diagnosis of deep and lateral free margins with Distrito Federal; Amanda Guedes Assis Dutra / Dutra, A. site reconstruction. Case Report: Patient O.R.C., 73 G. A. / Liga Acadêmica de Oncologia do Hospital de Base years old, commercial representative, presented in do Distrito Federal; Bruno José de Queiroz Sarmento / the first attendance on 11/01/2010 a nasal tip lesion Sarmento, B. J. Q. / Unidade de Cirurgia Oncológica do where he had already been treated with cauterization Instituto Hospital de Base; Rodrigo Nascimento Pinheiro and current recurrence. On November 24, 2010 / Pinheiro, R. N. / Unidade de Cirurgia Oncológica do performed the surgical procedure for removal of the Instituto Hospital de Base. lesion as well as reconstruction on the spot at the same time. The medical team opted for the use of the Case description: female white patient, 75 years old, nasogenian flap for site reconstruction. The sample was history of fourteen pregnancies, menopaused at 50 sent for anatomopathological analysis that presented years without hormone replacement, with hypertension, ulcerated basal cell carcinoma, deep and lateral free type 2 diabetes and dyslipidemia. With no family history margins, indicating the cure of this lesion. The patient of cancer, she has had a right inguinal lesion for 4 presented good integration and satisfactory aesthetic years without follow-up. Two months ago, the patient result. Conclusion: The removal of the lesion is chosen presented progression of lesions and local alterations in because it is the definitive treatment most suitable the inguinal skin, submitted to a biopsy that presented for this type of lesion, requiring reconstruction at the histopathology of mucinous adenocarcinoma and same surgical moment, either by primary synthesis or inconclusive immunohistochemistry. Abdominal the use of flaps. The chosen method takes into account tomography showed right inguinal cystic image the size of the lesion and the area that needs coverage. measuring 8.4 cm. Indicated for diagnostic evaluation The nasogenian flap is indicated for coverage of central and review of biopsy for possible metastasis of vagina areas of the face, especially nasal dorsum, wings of the carcinoma. Mammography revealed in the isodense nose and nasal tip, since the skin of the donor area is nodule at fibroglandular tissue, with circumscribed very similar to the recipient area. This is classified as a contours, located in the superolateral quadrant of interpolated flap in stages because it has the following the right breast. Fine-needle aspiration puncture was characteristics: vascular pedicle with a specific artery and performed on the breast lump indicating the presence its tributaries, distant donor area not contiguous to the of neoplastic cells. Microscopy was compatible with
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invasive carcinoma and, through immunohistochemistry, neoplasia sarcomatoid of high grade that before the has been confirmed the diagnosis of metastatic breast anatomo-contextcan correspond to a tumor Filoide adenocarcinoma. Discussion: In women, breast cancer maligna.Case Discussion: Breast sarcomas are rare is a more frequent malignancy and the leading cause neoplasms of low incidence, aggressive and high risk of cancer death in the world. Despite advances in early of metastatic dissemination. They present different detection and understanding of the molecular basis morphological patterns of the mesenchymal lineage of the disease, 10% of breast cancer patients have and correspond to less than 1% of malignant breast distant metastasis at the time of diagnosis. Tumor neoplasms.Generally it affects people at the fifth and heterogeneity of breast carcinoma is one of the biggest sixth age, however, the rarity of the case is extremely challenges, considering that tumors with the same relevant for the age group of the 21-year-old patient. The histological types, stages and degrees of differentiation histological type, clinical characteristics and imaging of may present different outcomes due to prognostic the breast sarcoma are non-specific, which complicates factors and responses to treatment implemented. The the early diagnosis and affects the prognosis, due to most common symptom is the appearance of a nodule, the extension of the treatment.Thus, In order to avoid usually painless, hard and irregular, but there are tumors an erroneous diagnosis, histopathological examination that are flag-shaped, globous and well described. Other with immunohistochemical confirmation is extremely signs are skin edema, retraction, pain, nipple inversion, important. The treatment for this type of cancer is hyperemia, and papillary discharge, especially when it primarily the simple mastectomy with or without is unilateral and spontaneous. Treatment depends on pectoral muscle resection.Final considerations:It staging and type. Final considerations:Breast cancer is evident that high-grade breast sarcoma poses a is a heterogeneous condition. Differences in clinical challenge to oncologic treatment since it is a type of presentation and prognosis are common, requiring neoplasm rare, aggressive and of bad prognosis.Thus, a personalized approach. We bring to knowledge The importance of reporting new cases associated with and discussion this clinical form of metastasis, which the literature review is verified for the accomplishment reaffirms the complexity of the disease and the need to of an early diagnosis and a specific treatment. expand the knowledge of its mechanisms. Contato: Eduarda Gabrielly da Costa Rodrigues Contato: Renata Pereira Fontoura [email protected] [email protected]
TEMÁRIO: ONCOMASTOLOGIA TEMÁRIO: ONCOMASTOLOGIA CÓDIGO: 87768 CÓDIGO: 85715 DIFFERENCE BETWEEN PUBLIC AND BREAST SARCOMA IN YOUNG ADULT: CASE PRIVATE SERVICES CONCERNING TYPE OF REPORT BREAST CANCER SURGICAL SPECIMEN IN Autores: Eduarda Gabrielly da Costa Rodrigues / PATIENTS SUBMITTED TO NEOADJUVANT Rodrigues,E.G.C. / universidade Nilton lins; Elane Frota CHEMOTHERAPY Aragão / Aragão,E.F. / universidade Nilton lins; Elia Frota Aragão / Aragão,E.F. / universidade fametro; Nilton Autores: Marcos Antônio Lima Carvalho / Carvalho, M. Cezar Oliveira Bessa / Bessa,N.C.O. / fundação cecon; A. L. / Universidade Federal de Sergipe; Loren Almeda Gabriel Oliveira Bessa / Bessa,G.O. / universidade Do Nascimento / Nascimento, L. A. / Universidade Nilton lins. Federal de Sergipe; Ana Catarina Ferreira Bispo / Bispo, A. C. F. / Universidade Federal de Sergipe; João Presentation of the case: Patient F.P.C.A., 21 years Eduardo Andrade Tavares de Aguiar / Aguiar, J. E. A. T. / old, female, 8 months ago reports the presence of a Universidade Federal de Sergipe; érika de Abreu Costa bulky nodule of 3 cm in the left breast. Upon physical Brito / Brito, E. A. C. / Universidade Federal de Sergipe; examination, it evidenced an accelerated growth of the Hugo Leite de Farias Brito / Brito, H. L. F. / Universidade nodule.It was referred to the ambulatory of Mastologia, Federal de Sergipe. where a USG was requested, informing nodule in left breast, measuring 4.9x4.1cm, report BI-RADS VAT. The Introduction: Conservative surgery to initial breast anatomopathological evidenced nuclear pleomorphism cancer must be the first-choice procedure to control the suggesting: benign phyloid tumor.Without the study disease locoregionally. Neoadjuvant chemotherapy is a of immunohistochemistry, the young woman was current alternative to increase the rates of conservative submitted to a left quadrantectomy.Thus, 4 months surgery in non-candidate patients due to inappropriate ago, the patient performed the self-examination breast volume/tumor size. Objective: To compare the and,was referred to the oncologic reference center, age, surgical and pathological variables of malignant where chest x-rays were requested,Chest CT, upper breast cancer in patients submitted to public and abdomen CT and bone scintigraphy.The results were private neoadjuvant chemotherapy. Methods: This is a of rounded lesions with lobulated contours, measuring retrospective and descriptive study of breast carcinoma about 4.1x4.1cm in the left breast.In view of this result, undergoing neoadjuvant treatment cases during the a simple mastectomy was performed in the left breast period from January 2011 to December 2017. The with the resection of part of the pectoral muscle as a sample was selected from the analysis of public and safety margin. The anatomopathological presented private medical records located in Aracaju-SE. The fusocellular sarcoma of high grade.Finally, the variables obtained were: age group (40 years old/under immunohistochemical study confirmed for malignant and over 40 years old); type of service (private or public);
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type of surgical specimen (conservative surgery or total nutricional e sintomas de náuseas, vômitos, sede e mastectomy) and histological type of the neoplasia. fome no período de jejum pré-operatório. Resultados: a After the survey, a descriptive analysis was performed, amostra foi composta por 28,7% de homens e 71,3% de calculating the frequencies and arithmetic mean of the mulheres com idade média de 53,3±13,6 anos. O tempo variables in both groups of patients. Results: A total of médio de internação foi de 2,6±3,0 dias. O estado 101 patients were analyzed, 39 from private network nutricional mais prevalente foi a eutrofia, com 42,1% and 62 from public network. In the private service, 14 da amostra. As náuseas foram presentes em 13,5%, patients (35.90%) were aged 40 years old or younger, 25 vômitos em 1,8%, fome em 36,8% e sede em 48%. Na (64.10%) is the frequency found in the group older than comparação dos grupos, os pacientes que abreviaram 40 years. Regarding the types of breast resection, 10 o jejum apresentaram menos fome e sede (p<0,0001 (25.64%) were submitted to total mastectomy, while 29 e p<0,0001), respectivamente. Não houve diferenças (74.36%) underwent conservative surgery. In the public significativas para redução de náuseas e vômitos. sector, 15 patients (24.19%) were 40 years old or younger Conclusão: o consumo de suplemento nutricional rico and 47 (75.81%) were older than 40 years. According to em maltodextrina mostrou efeito benéfico na sensação the types of surgical specimens, 58 (93.55%) underwent de desconforto do paciente no período de jejum pré- total mastectomy, while only 4 (6.35%) underwent operatório, além de ser uma prática que favorecerá a conservative surgery. It is important to state that one redução de complicações pós-operatórias e tempo de of the patients from the public network presented internação. tumor bilaterally. Finally, invasive ductal carcinoma was the most prevalent histological type in both services, Contato: Thais Manfrinato Miola accounting for 73.47% of public service neoplasia and [email protected] 89.65% of the private sector. CONCLUSIONS: It is noted that, in both services, the largest number of women with carcinoma corresponds to patients older than 40 TEMÁRIO: ONCOMASTOLOGIA years. Furthermore, it is clear that the most common CÓDIGO: 87429 histological type is invasive ductal carcinoma. However, while the private institution had higher rates for EPIDEMIOLOGICAL PROFILE OF BREAST conservative surgery, the public sector showed a higher NEOPLASMS IN BRAZILIAN FEMALE frequency of total mastectomies. POPULATION FOR THE PERIOD OF 2008-2018 Contato: Marcos Antônio Lima Carvalho Autores: Caenna Corrêa e Correia / Correia, C. C. / [email protected] FMB/UFBA - LANACC/FMB; Beatriz Gedeon Cubilhas / Cubilhas, B. G. / EBMSP - LANACC/FMB; Gildásio Do Nascimento Santos Junior / Santos Junior, G. N. / FMB/ TEMÁRIO: ONCOMASTOLOGIA UFBA - LANACC/FMB; Hortênsia Souza Guedes de CÓDIGO: 85106 Oliveira / Oliveira, H. S. G. / EBMSP - LANACC/ FMB; Ian Lemos Teixeira Sarno / Sarno, I. L. T. / EBMSP - LANACC EFEITOS DA ABREVIAÇÃO DE JEJUM /FMB; Milla Gabriele Sallenave Andrade / Andrade , PRÉ-OPERATÓRIO NO DESCONFORTO M.G.S. / EBMSP - LANACC /FMB; Pedro de Brito Oliveira DO PACIENTE SUBMETIDO À CIRURGIA / Oliveira, P.B. / EBMSP - LANACC /FMB; Renata Cristina Perez de Magalhães / Magalhães, R.C.P. / EBMSP - ONCOLÓGICA ELETIVA LANACC /FMB; Ana Célia Diniz Cabral Barbosa Romeo Autores: Thais Manfrinato Miola / Miola, TM / / Romeo, A. C. D. C. B. / FMB/UFBA; André Luis Barbosa ACCamargo Cancer Center; Fernanda Ramos de Oliveira Romeo / Romeo, A.L.B. / EBMSP. Pires / Pires, FRO / ACCamargo Cancer Center. Introduction: Breast cancer is the one that most affects Introdução: a abreviação de jejum pré-operatória tem women worldwide, with 1.38 million new cases and 458 sido cada vez mais preconizada nos pacientes cirúrgicos, thousand deaths per year, according to WHO. There are pois além de reduzir a resistência à insulina no intra- several types of this neoplasm, and most cases have a operatório, complicações no pós-operatório, proteólise good prognosis. For the year 2018, 59,700 new cases muscular e tempo de internação, traz maior conforto of breast cancer were estimated in Brazil. Objective: ao paciente, reduzindo sintomas que podem aparecer To delineate the epidemiological profile of patients no período de jejum. Objetivo: avaliar os efeitos da hospitalized in Brazil with malignant breast cancer, abreviação de jejum pré-operatório no desconforto focusing on females, between 2008 and 2018. Method: de pacientes cirúrgicos oncológicos eletivos. Materiais Through the Sistema de Informações Hospitalares (SIH e Métodos: o estudo foi do tipo coorte prospectivo / DATASUS) database, hospitalizations were analyzed e observacional, onde 110 pacientes receberam and deaths related to malignant breast cancer in Brazil, suplemento nutricional isento de resíduos e rico em from 2008 to 2018, especially in women. Refers to an maltodextrina 6 horas e 2 horas antes da cirurgia e ecological study with a quantitative, descriptive and 61 mantiveram 8 horas de jejum antes da cirurgia. temporal approach, in which the variables studied A realização da abreviação de jejum já é protocolo were: number of hospitalizations and deaths according institucional sendo categorizado para uso do suplemento to year, region, race, and age in addition to the value pela avaliação do anestesista. Os pacientes incluídos total and average according to regions. Results: no estudo foram submetidos às cirurgias de pequeno Hospitalizations for malignant breast cancer increased e médio porte da oncomastologia, uro-oncologia e over time, with 37,744 in 2008 and 63,542 in 2018. These oncoginecologia. As variáveis avaliadas foram o estado were more frequent among self-reported white women,
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totaling 263,098, and less frequent among indigenous acceptance of a new woman, a new body (FURLAN et women, who make up only 237. Mortality was the other al., 2013). Objective: To analyze the changes that occur way around, with 13.08 among indigenous women and after a mastectomy in the female body image through 8.07 among white women. Among age groups, mortality the eyes of the spouse. Method: A descriptive field study was highest between 1-4 years, at 16.67, followed by with a qualitative approach was performed. Results: 80 years and over, at 15.76. The age group with the A total of 4 spouses between 41 and 57 years old largest number of hospitalizations was between 50- participated in the interviews. From an understanding 59 years old, representing 158,348 cases. Women that mastectomy affects not only the physical body, from the Southeast region had the highest number but also emotional integrity, after a mutilating surgery of hospitalizations, with 290,894, in the referred time exposing these women to the challenge of recognizing interval. However, it was the Northeast region that themselves living in a new body (PANOBIANCO, et al., presented the highest average value of hospitalizations, 2018). Given this context, two categories emerged from being R $ 2,062.28. Conclusion: There is an increase in the reports, highlighting that the spouses see their hospitalizations for malignant breast cancer during the wives‘ bodies with a different look. Aesthetic issues study period, which may be justified by the increased are less important when compared with the state of worldwide incidence of this cancer. There was a physical and mental health after treatment. These higher number of hospitalizations and lower mortality changes charged with feelings of self-denial undermine among self-declared white women, and the opposite their affective relationships by placing them in constant among indigenous women, which can be attributed search for compromised female identity (LOPES AND to difficulties in accessing health in socially vulnerable AZEVEDO, 2010). It was also possible to perceive the groups. Finally, the highest hospitalization rate of 50-59 fear of these partners against the dissatisfaction of years may be related to the use of mammography for their partners with self-image and the risks of surgical screening, which begins after 50 years. and aesthetic procedures. Conclusion: The study brought a possibility to explore the spouse‘s gaze as a Contato: Caenna Corrêa e Correia female mirror from companionship and complicity. It [email protected] reflects this body full of new forms and traits and how this way of seeing your partner is able to influence and contribute to the acceptance of this new identity and TEMÁRIO: ONCOMASTOLOGIA the reconstruction of life goals after the diagnosis and CÓDIGO: 87474 treatment of the disease.
FEMALE BODY IMAGE AND ITS MIRROR FROM Contato: Emanuela Marques Pereira Sales A COMPANION‘S LOOK: WHAT CHANGES [email protected] AFTER A MASTECTOMY Autores: Andréa Stopiglia Guedes Braide / Braide, A. S. TEMÁRIO: ONCOMASTOLOGIA G. / Centro Universitário Christus; Ana Mayra Barbosa CÓDIGO: 87968 Ferreira / Ferreira, A. M. B. / Centro Universitário Christus - UNICHRISTUS; Cristiani Nobre de Arruda HISTORICAL ANALYSIS OF 2003 TO 2013 OF / Arruda, C. N. / Universidade de Fortaleza - UNIFOR; THE CLINIC EPIDEMIOLOGICAL PROFILE Emanuela Marques Pereira Sales / Sales, E. M. P. / OF PATIENTS WITH IN SITU DE BREAST Centro Universitário Christus - UNICHRISTUS; Francisco Antonio da Cruz Mendonça / Mendonça, F. A. C. / CARCINOMA IN MANAUS - AM Estácio - FIC; Henrique Barros / Barros, Henrique. / Autores: Lailson Melgueira Navarro / Navarro, L.M / ISPUP - instituto de saúde publica da Universidade da Universidade do Estado do Amazonas; Larissa Pessoa porto - Faculdade de Medicina do Porto; José Manuel de Oliveira / De Oliveira, L.P / Universidade Federal do Peixoto Caldas / Caldas, J. M. P. / ISPUP - Universidade Amazonas; Angeli Alexandra Caro Contreras / Contreras, do Porto; Márcia Cardinalle Correia / Correia, M. A.A.C / Universidade do Estado do Amazonas; Sarah C. / Centro Universitário Christus - UNICHRISTUS; Susan Rodrigues Tavares / Rodrigues, S.S / Universidade Paulla Vasconcelos Valente / Valente, P. V. / Centro Federal do Amazonas; Renata Maravieski Pareja / Universitário Christus - UNICHRISTUS. Pareja, R.M / Universidade do Estado do Amazonas; Rejaine Ribeiro Vilela / Vilela, R.R / Universidade do Introduction: Breast cancer is the disease that kills Estado do Amazonas; Leandro Castro Breves / Breves, most women worldwide. (LIMA et al., 2017). The L.C / Universidade do Estado do Amazonas; Jander causes involve hormonal, hereditary factors, cell aging, Rafael Nogueira da Silva / Silva, J.R.N / Fundação Centro inadequate diet, among others (SANTANA et al., 2017). de Controle de Oncologia do Estado do Amazonas; Hilka Mastectomy is the most commonly performed therapy Flávia Barra Do Espirito Santo Alves Pereira / Pereira, in the female population when referring to breast MESA / Fundação Centro de Controle de Oncologia do carcinoma, which requires greater biopsychosocial Estado do Amazonas. care (CUNHA et al., 2011). Surgery is surrounded by physical and mental pain and flooded with emotions Introduction: Breast cancer is pointed as one of associated with body mutilation, such as fear of loss of the main causes of death among women. In its female identity, alteration of body image and sexuality classification, carcinoma in situ is characterized by an (OLIVEIRA et al., 2017). However, their quality of life and abnormal multiplication of the ductolobular breast self-esteem also contribute to the emotional health cells. The high morbidity and mortality rates and of their partners towards them, especially for the the occurrence of this disease worldwide show the
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importance of developing and investigating means da Silva / Silva, A. M. R. / Santa Casa de Misericórdia de for early detection and diagnosis. Objective: To draw Maceió; Elson Alexandro Cordeiro Folha Filho / Filho, E. a social epidemiological and clinical profile of patients A. C. F. / Santa Casa de Misericórdia de Maceió. diagnosed with breast cancer in situ and treated at a referral center for oncology in the Amazon. Method: Introduction: Patients undergoing mastectomies with Retrospective longitudinal descriptive study was axillary dissection suffer greatly from postoperative performed based on the analysis of 75 medical records pain and discomfort, so sought to study regional of patients diagnosed with carcinoma in situ between blockade techniques that could minimize such effect, 2003 and 2013. During collection, data regarding such as Interpectoral block (PEC). This innovative gender, age, origin, histological type and treatment were technique can become an analgesic option widely used cataloged. Inclusion criteria were patients with in situ in axillary surgery due to the low complication rate breast carcinoma. The exclusion criterion was medical and the single puncture characteristic technique that records that were not properly completed. Results: The allows simultaneous blockade of various dermatomes, survey was conducted in only 56 records, considering reducing postoperative pain and The abusive use of that 19 of them had incomplete information. Regarding opioids and their complications. Objectives: To disclose gender, only one patient was male, the others were the anesthetic blockade technique performed in an female. The age range ranged from 30 to 63 years. Of oncologic surgery service, in order to expose alternatives the total patients, the predominant age group is 50-59 for postoperative pain control in mastectomy patients. years old with 36%, followed by the age group 40-49 Method: PEC blockade performed after general years old with 30%, the age group older than 60 years anesthesia induced with fentanyl and Propofol and 21% and the lowest incidence is between 30-59 years in maintenance with Sevoflurane and Remifentanil old. 39 presented 13%. Regarding the naturalness, the in infusion pump. Ultrasoundguided technique with prevalence of patients in Manaus is 75%, while 16% injection of levobupivacaine with vasoconstrictor in are from the interior of the state, and 0.9% from other the concentration of 0.37%, with infiltration of 10ml states in the northern region (Pará, Maranhão and Acre). between pectoral muscles and 20ml between the Regarding the histological type of the tumor, there was pectoral minor and the sawdust muscle, followed by a predominance of the unspecified DCIS type with 55%, the surgical incision. All patients are evaluated in the followed by the Comedo type with 27%, the Solid type postoperative period by the pain scale and receive presented the incidence with 9%, the Cribiform with 7% prescription of dipyrone and/or tramadol, administered and the Papillary and Micro papillary type, both having if necessary to not mask the level of pain. Results: The the same incidence of 2% each. Conclusion: It showed main study showing that the PEC blockade reduces an incidence of 3.5% of patients with DCIS, being the postoperative pain after mastectomies with axillary most affected age group from 50 to 59 years. Most of approach, minimizing the use of opioids and their the patients are from the capital of Amazonas, followed complications, was published by Blanco in 2011. In 2018 by municipalities in the interior and other states. DCIS it was implanted in this referral service in oncological is still a major challenge in early detection, and the vast surgery of Maceió with good postoperative response knowledge that has yet to be established in studies of and evidence of better satisfaction of patients with these precursor lesions will add information that will pain control after analysis of the EVA scale available contribute to better conduct these cases. postoperatively. Conclusion: The pectoral block technique (PEC) is easy to perform and feasible with Contato: Lailson Melgueira Navarro better pain control of patients in the postoperative [email protected] period of radical mastectomies with axillary approach.
Contato: Amanda Lira dos Santos Leite TEMÁRIO: ONCOMASTOLOGIA [email protected] CÓDIGO: 87531
INTERPECTORAL ANESTHETIC BLOCK (PEC) TEMÁRIO: ONCOMASTOLOGIA IN RADICAL MASTECTOMIES WITH AXILLARY CÓDIGO: 87660 APPROACH: AN ALTERNATIVE TO PAIN LOCALLY ADVANCED BREAST CANCER AND CONTROL IN AN ONCOLOGY SURGERY STAGE IV, A PALIATIVE APPROACH: TWO SERVICE IN MACEIÓ CASES REPORT Autores: Amanda Lira dos Santos Leite / Leite, A. L. S. / Santa Casa de Misericórdia de Maceió; Frederico Autores: Manuella Caroline Dutra Frazão Alves / FRAZÃO Theobaldo Ramos Rocha / Rocha, F. T. R. / Santa Casa de ALVES, M. C. D. / Universidade Federal do Estado do Rio Misericórdia de Maceió; Aldo Vieira Barros / Barros, A. de Janeiro - UNIRIO; Aline Dessimoni Salgado / SALGADO, V. / Santa Casa de Misericórdia de Maceió; Claudemiro A. D. / Universidade Federal do Estado do Rio de Janeiro de Castro Meira Neto / Neto, C. C. M. / Santa Casa de - UNIRIO; Danielle Rodrigues Neves da Costa / COSTA, D. Misericórdia de Maceió; Robério Silva Melo / Melo, R. N. / Universidade Federal do Estado do Rio de Janeiro R. S. / Santa Casa de Misericórdia de Maceió; Diego - UNIRIO; Eduarda Vieira Rodrigues / RODRIGUES, E. V. Windson de Araújo Silvestre / Silvestre, D. W. A. / Santa / Universidade Federal do Estado do Rio de Janeiro - Casa de Misericórdia de Maceió; Tainá Santos Bezerra UNIRIO; Lara Pikelhaizen Rodrigues Velloso / VELLOSO, / Bezerra, T. S. / Santa Casa de Misericórdia de Maceió; L. P. R. / Universidade Federal do Estado do Rio de Thiago Yamamoto Amaral / Amaral, T. Y. / Santa Casa Janeiro - UNIRIO; Luiza Preza Rodrigues / RODRIGUES, L. de Misericórdia de Maceió; Alberson Maylson Ramos P / Universidade Federal do Estado do Rio de Janeiro -
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UNIRIO; Maria Victória Schmidt Hohl Ferreira / FERREIRA, Freitas / FREITAS, Y.B.C / UNIFAMINAS-MURIAÉ; Liuana M. V. S. H. / Universidade Federal do Estado do Rio de Carvalho de Souza / SOUZA, L.C / UNIFAMINAS-MURIAÉ; Janeiro - UNIRIO; Mariana Quintela Rodrigues Pereira / André Ellias / Ellias, A. / PUCMINAS; Rafael Batista PEREIRA, M. Q. R. / Universidade Federal do Estado do de Souza / Souza, R. B. / FAMINAS- BH; Luiza Ohasi Rio de Janeiro - UNIRIO; Renan Geronimo Souza da Silva / de Figueiredo / Figueiredo, L, O. / Hospital Alberto SILVA, R. G. S. / Universidade Federal do Estado do Rio de Cavalcanti - FHEMIG; Adymila Salim Moreira de Rezende Janeiro - UNIRIO; Antonio Felipe Santa Maria Coquillard / Rezende, A.S.M. / Fundação Cristiano Varella - Hospital Ayres / Santa-Maria AF / Universidade Federal do Estado do Câncer de Muriaé. do Rio de Janeiro - UNIRIO. Clinical case: Female patient, 71 years old, complaining of Case Report: Case 1: A.S.N., 42, reports a left breast fast-growing lump in the left breast, noted about 3 months tumor with skin ulcerations. Core Biopsy revealed negative prior, measuring approximately 2.5 cm in its largest triple infiltrating ductal carcinoma. We also found nodal dimension. Had positive family history for Breast Cancer. conglomerate in the left axilla, multiple pulmonary Submitted to a quadrantectomy with tumor excision, metastasis and wide locoregional infiltration. After which showed characteristics of osteosarcoma, measuring chemotherapy and radiotherapy there was progression, 2.3 x 1.9 x 1.3 cm, with free resection margins and sentinel and radical mastectomy, Halsted, was indicated, because lymph node resection without evidence of neoplasia. For the breast was totally tumoral, with extensive areas of diagnostic confirmation, an immunohistochemical study necrosis, infection and bleeding. For reconstruction, was performed and the following markers were tested: the abdomen flap was chosen. There were no intra and cytokeratin 40, 48 50 and 50.6 KDa; estrogen receptor; postoperative complications. Patient has a MSE thrombosis desmin; S-100 protein; p63 and CD34 protein. All with due to tumor invasion of the left axillary vein and remains negative results. The final immunohistochemical report in outpatient control and is accompanied by clinical pain. confirmed high grade malignant neoplasia with osteoid Case 2: M.J.S., 98 years old, demented, with ulcerated and formation. The mammography and analysis of the surgical bleeding tumor in the left breast. Core Biopsy revealed specimen, helped corroborate the diagnosis of primary infiltrating ductal carcinoma. Chemotherapy was started osteosarcoma of the breast (POB). Discussion: POB is a and suspended due to toxicity. After admission to our rare and aggressive tumor, accounting for about 1% of service, she underwent a radical mastectomy at Madden, mammary neoplasms. It is characterized for producing with primary reconstruction using an abdominal flap, osteoid, bone or chondroid material, being located in since the tumor was locally advanced. Surgical specimen soft tissue without attachment to the skeleton. According confirmed initial diagnosis and revealed 2 macroscopically to the cellular composition it is classified as fibroblastic, positive lymph nodes among the 25 resected. There osteoblastic or osteoclastic. The carcinogenesis of this were no intra and postoperative complications. Patient tumor is not well defined and is believed to be derived referred to clinical oncology for axillary radiotherapy from pluripotent mammary stromal cells or from and hormone therapy. Follows control and no evidence transformation of a fibroadenoma. The first step in of neoplastic disease. Discussion: 80% of breast cancer determining a diagnosis is biopsy. Imaging exams, such cases in underdeveloped countries are advanced (III or as computed tomography scans (CT), are useful for ruling IV) tumors, and invasive surgery is the recommended out differential diagnosis. Differential diagnosis of POB therapeutic alternative to prioritize life maintenance. includes carcinosarcoma and metastatic osteosarcoma, Conservative surgery removes part of the mammary gland mainly of the chest wall. The latter commonly produces with the tumor, but does not increase significantly the breast metastases, making the diagnosis of POB difficult. local recurrence rate. But the mastectomy removes the Thus, CT scans assists differentiating the two. Regarding entire mammary gland, aiming to reduce the incidence treatment, it is based on radical or simple mastectomy and improve the life expectancy of women from high- and chemotherapy; in some studies, it is emphasized risk populations, and is almost always unavoidable in that perioperative chemotherapy increases the survival advanced stages. Final comments: The literature shows rate in these patients. Axillary lymphadenectomy is only that palliative mastectomies are feasible, safe and may recommended with evidence of lymph node involvement represent a gain in quality of life for selected patients. and radiotherapy is performed for large, high-grade However, early detection, involving screening and diagnosis tumors with compromised margins. Final comments: in early stages, is considered a priority in coping with Wide resection or total mastectomy are good treatment breast cancer. Physical, psychic and social rehabilitation options, except when the margins are compromised, should be approached as a public health problem, whose because the possibility of recurrence is significant. effectiveness has better treatment outcomes. Contato: Mariana Miranda Garcia Contato: Manuella Caroline Dutra Frazão Alves [email protected] [email protected]
TEMÁRIO: ONCOMASTOLOGIA TEMÁRIO: ONCOMASTOLOGIA CÓDIGO: 88365 CÓDIGO: 87715 STATISTICAL ANALYSIS OF THE CONSERVATIVE PRIMARY OSTEOSARCOMA OF THE BREAST SURGICAL APPROACH TO BREAST CANCER AND THERAPEUTIC CONDUCT IN THE PUBLIC SECTOR: THE SCENARIO OF A Autores: Mariana Miranda Garcia / Garcia, M. M. / CAPITAL IN AMAZON FAMINAS-BH; Laryssa Constância Silveira / Silveira, L. Autores: Daniel Mendonça de Almeida / Almeida, C. / UNIFAMINAS-MURIAÉ; Yasmim Bochear Cortes de D.M. / Universidade Federal do Pará; Hendy Sheiijy
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Taniyama Dantas / Dantas,H.S.T. / Universidade Leite / LEITE, A. L. S. / Santa Casa de Misericórdia de Federal do Pará; Raíssa Souza de Oliveira / Oliveira,R.S. Maceió; Diego Windson de Araújo Silvestre / SILVESTRE, / Universidade Federal do Pará; Afonso Moraes Melo D. W. A. / Santa Casa de Misericórdia de Maceió; Thiago Júnior / Júnior,A.F.M. / Universidade Federal do Pará; Yamamoto Amaral / AMARAL, T. Y. / Santa Casa de Maria Luíza Alves Cobiniano de Melo / Melo, M.L.A. / Misericórdia de Maceió; Alberson Maylson Ramos da Universidade Federal do Pará; Luiz Felipe Macena de Silva / SILVA, A. M. R. / Santa Casa de Misericórdia de Avelar / Avelar, L.F.P. / Universidade Federal do Pará; Maceió; Elson Alexandro Cordeiro Folha Filho / FOLHA Thalita da Rocha Bastos / Bastos, T.R. / Universidade do FILHO, E. A. C. / Santa Casa de Misericórdia de Maceió; Estado Pará. Igor Lima Buarque / BUARQUE, I. L. / Centro de Ensino Superior de Maceió (CESMAC). Uma das maiores dificuldade dentro do sistema público de saúde é promover atendimento a seus pacientes de Case Report: A 63-year-old female patient was referred maneira ágil, seja por questões estruturais ou mesmo to a Maceio Oncology Surgery Reference Service de dimensionamento da demanda requerida para with a history of right breast nodulation and reddish atender com isonomia seus cidadãos. O câncer de tumor mass in the left breast. It performed breast and mama é a neoplasia mais incidente entre mulheres, mammography US with evidence of bilateral tumor excluindo as neoplasias ligadas a pele. Corresponde suggestive of right armpit neoplasia and adenopathy. a 59.700 novos casos e cerca de 30% do número total Performed core biopsy with diagnosis of invasive ductal de neoplasias do sexo feminino. O diagnóstico é feito a carcinoma in the right breast and phyllodes tumor partir das associações entre sinais e sintomas, exames in the left breast. Clinical staging revealed metastatic de imagem e a confirmação anatomopatológica, sendo disease with multiple pulmonary nodules, lytic lesions a última tida como padrão ouro. A associação desses on vertebral bodies and costal arches and liver nodules. dois cenários cria um desafio para oncologia no qual The patient was submitted to a chemotherapy with o tempo de espera entre atendimentos, exames e partial response in the right breast, but the left breast diagnóstico da patologia se torna um fator modificador lesion progressed, it is recommended and submitted da doença. Buscando analisar possíveis correlações a palliative surgical treatment with simple bilateral entre o a espera por questões associadas diagnóstico, mastectomy. Discussion: Bilateral synchronic breast custos e taxas de mortalidade associada a mastectomia neoplasia is defined as the simultaneous presence of 2 de caráter conservador e o impacto sobre o prognóstico primary tumors at diagnosis or that are detected within da doença o estudo possui caráter epidemiológico e the first 12 months of diagnosis of the first tumor. The descritivo de dados disponíveis no DATASUS. Foram incidence oscillates between 0.3 and 12%. Phyllodes analisados os casos de câncer de mama do estado malignant breast tumor is rare, accounting for less than do Pará nos anos de 2008 até 2018. Os dados foram 1%. Its treatment consists of surgical resection with free organizados no Microsoft Excel e, comparou-se aos margins or mastectomy. Adjuvant should be considered dados em âmbito estadual e nacional. Dentre os in cases of recurrent, malignant or metastatic tumors. anos de 2007 e 2018, foram registrados 221 óbitos e Metastases are rare and the most common sites are 593 internações relacionados a neoplasia maligna de lungs (66%), bones (28%) and brain (9%), with preferential próstata no estado do Pará. O custo médio de entre hematogenous spread, rarely affecting lymph nodes os anos de 4725,28 reais, mostra-se que os valores (<1%). Invasive ductal carcinoma represents 80 to 90% of relacionados a internação apresentaram gastos com breast carcinomas and its treatment is multimodal with os procedimentos, partindo de 3133,81 em 2007 para association of surgery, chemotherapy, radiotherapy and 5278,28 em 2018. O reflexo é a queda do número de / or hormone therapy, depending on disease stage and óbitos pós-procedimento de 0,62 óbitos para cada immunohistochemical pattern. Concluding Remarks: mil hab. nos período e de 3,03 em 2011 para 1,72 Synchronous bilateral breast cancer is rare and when em 2018, com uma redução de 2,1 na média de dias the histological types are different, the case becomes de internação. Nacionalmente, a taxa de mortalidade even more special. Malignant phyllodes tumor has its no mesmo período é de 0,37 e a média de dias de treatment based on surgery, as it was done in this case, internação de 6 dias. and ductal carcinoma, because it is stage IV, selects chemotherapy as the basic treatment, however surgery Contato: Daniel Mendonça de Almeida can be performed in selected cases with better quality of [email protected] life and lower disease progression.
Contato: Tainá Santos Bezerra TEMÁRIO: ONCOMASTOLOGIA [email protected] CÓDIGO: 87588
SYNCHRONOUS BILATERAL BREAST CANCER : TEMÁRIO: OUTROS E MISCELÂNIA TUMOR PHYLLODES MALIGNO AND DUCTAL CÓDIGO: 87479 CARCINOMA - CASE REPORT ABDOMINOPELVIC EPENDYMOMA: REPORT Autores: Tainá Santos Bezerra / BEZERRA, T. S. / Santa OF A RARE CASE Casa de Misericórdia de Maceió ; Frederico Theobaldo Ramos Rocha / ROCHA, Frederico Theobaldo Ramos / Autores: Lara Ribeiro Cruz / CRUZ, L.R. / Universidade Santa Casa de Misericórdia de Maceió; Robério Silva Federal da Fronteira Sul (UFFS); Mariana Miyasaki Melo / MELO, R. S. / Santa Casa de Misericórdia de Piovesana / PIOVESANA, M.M / Hospital do Câncer de Maceió; Aldo Vieira Barros / BARROS, A. V. / Santa Casa Londrina; George Câmara Lopes / CAMARA LOPES, de Misericórdia de Maceió; Amanda Lira dos Santos G. A. / Hospital do Câncer de Londrina; Marcela Maria
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Jorge Uchôa / UCHÔA, M. M. J. / Hospital do Câncer de Karoline Friedrich Foiato / Foiato, T.K.F. / UniCesumar; Londrina; Tassiara da Silva / SILVA, T. / Hospital do Câncer Cleiton Schweitzer Peron / Peron, C.S. / Clínica Proneuro; de Londrina; Veruska Peron / PERON, V. / Hospital do Ademar Dantas Cunha Junior / Cunha, A.D.J. / Uopeccan; Câncer de Londrina; Rafael Onuki Sato / SATO, R. O. / Alessandra Parmegiani de Biasio / Biasio, A. P. / Centro Hospital do Câncer de Londrina. Universitário Assis Gurgacz; Mônica Meneguette Silveira / Silveira, M. M. / Centro Universitário Assis Gurgacz; Case Report: A 22-year-old female patient was referred Ana Carolina Sayuri Tanamati / Tanamati, A.C.S. / to our service in August 2018 due to an increased Universidade Federal do Parana. of abdominal volume since the beginning of 2018. Computed tomography (CT) revealed peritoneal mass Metastatic cancer is a disease with an uncertain on the right side under the liver, which was invading the presentation as stated by miscellaneous research data. liver and causing protrusion of the lungs. There was a The incidence of this feature is still uncertain due to lack mass on the left side between the liver and the spleen. of case reports. The most common subtype of this form Ascites and carcinomatosis were seen. Pelvic CT showed of metastasis is lung cancer, responsible for approximately a mass in the right iliac fossa, 67mm diameter and other 50% of all cases, followed by some less common injuries in the whole pelvic cavity. Chest CT showed malignancies such as breast cancer, prostate cancer, pleural effusion. Serological markers were CA-125: 29 U/ lymphoma, melanoma and renal cell carcinoma. The conus ml; CEA: < 0,5 ng/ml; CA19-9:17 U/ml. The patient was medullary metastasis is the least incident metastasis of the hospitalized to underwent an exploratory laparoscopic neuraxis topography. The malignancy arrival can occur procedure and was classified as ASA I. The surgery started through two main pathways: the arterial pathway and the with a supraumbilical surgical incision with dissection intramedullary venous plexus pathway. The most common to the abdominal cavity, which revealed peritoneal clinical presentation is pain related to the topography carcinomatosis and other injuries on the abdominal cavity of the lesion, followed by loss of muscular force and and injuries in the ovaries, but it doesnt seen to be the sensitivity; the progression of the neurological symptoms primary site of the disease. The biopsy were positive for generally occurs in the first month after the initiation of the vimentin, GFPA, CD99, EMA dot pattern and estrogen symptoms. The diagnosis is estabelished through a spinal receptor and negative for other markers like sexual MRI, containing T1 and T2 sagital images and axial images cord/gonadal stroma, embrionyc and neuroendocrine. of the affected vertebra plus imaging of two lower and The diagnostic conclusion was an abdominopelvic upper vertebral segments. The spinal MRI is indicated in 48 ependymoma. The patient started chemotherapy with hours after total loss of neurological function; the recovery Etoposide 100mg/m² and Cisplatin 20mg/m² D1-D5 21 days, of neurological function is virtually zero after this 48-hour for six cycles until april 2019, with a clinical improvement. period. The main treatment consists in surgical resection The patient underwent to a new surgery procedure on july of the lesion and can be complemented or substituted 2019, but the complete resection of the tumor was not by radiotherapy or chemotherapy depending on the possible. Discussion: Ependymomas rarely occurs out of patient‘s medical condition. The overall survival prognosis the neural system. The glial fibrillary acid protein (GFAP) is is reserved to those with multiple intramedullary lesions one of the most popular markers used in neuro-oncology with or without associated encephalic lesions. This case cases, expressed in a ependymomas too. Tumor resection report is about a 53 y.o, white female with primary breast is the best therapy for ependymomas and it can get better cancer who underwent total mastectomy (pT2N1M0, when associated with radiotherapy and chemotherapy. positive hormonal receptor, Ki67- 20%) in 2008 associated The clinical course is indolent. Conclusion: Ependymoma, with chemotherapy (AC regimen x4 + tamoxifen) for 10 when it happens out of the nervous system, is extremely years. In June, 2018 the patient reported starting feeling rare. The symptoms reported by the patient were dizziness symptoms. The patient then underwent a nonspecific, which makes the diagnosis more difficult. cranial CT in which a left cerebellar mass was found. The After the surgery procedure and the pathology report patient was referenced to a neurosurgery service in which showing positive reaction for GFAP, EMA dot pattern she underwent a left cerebellar hemisphere resection. and vimentin, was possible to arrange a treatment to Anastrozol and CNS radiotherapy were indicated. Three stabilize the progression of the tumor. Abdominopelvic months after the neurosurgical resection, the patient ependymomas must be one of the differential diagnoses manifested symptoms of paresthesia and paresia in lower of the gynecologist and gastroenterologist cancer team limbs rapidly progressing to paralysis. A new MRI identified and the diagnostic conclusion is result of the efforts of the a mass at T12/L1 level (conus medullaris level); the patient clinical, surgery and pathology team. underwent surgical resection of the newly found mass with no improvement of her clinical condition. The patient Contato: Lara Ribeiro Cruz died in December, 2018. [email protected] Contato: Tariane Friedrich Foiato [email protected] TEMÁRIO: OUTROS E MISCELÂNIA CÓDIGO: 87884 TEMÁRIO: OUTROS E MISCELÂNIA AN UNUSUAL NEURAXIS METASTASIS CÓDIGO: 87668 PRESENTATION ASSESSMENT OF MOBILE PHONE Autores: Eduardo de Biasio Milano / Milano, E.B. / APPLICATIONS FOR SURGICAL ONCOLOGY Centro Universitário Assis Gurgacz; Tariane Friedrich Foiato / Foiato, T.F. / CEONC- Cascavel; Bruno Rafael Autores: Kleyton Santos de Medeiros / MEDEIROS KS / Kunz Bereza / Bereza, B. R.K. / CEONC- Cascavel; Tauana Universidade Federal do Rio Grande do Norte; Brenda
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de Oliveira Silva / SILVA BO / Centro Universitário do Rio com história dor abdominal, náusea e vômitos, e Grande do Norte; Danielly Isabel Gomes de Lima / LIMA distensão abdominal. Não apresentava história de DIG / Universidade Federal do Rio Grande do Norte; tabagismo ou etilismo. Referia tratamento prévio para Beatriz Stransky / STRANSKY B / Universidade Federal transtorno depressivo. História da doença, há 2 meses do Rio Grande do Norte; Ana Katherine Gonçalves / iniciou dor abdominal leve, região de hipogástrico, sem GONÇALVES AK / Universidade Federal do Rio Grande alteração hábitos intestinais, episódios esporádicos do Norte. de sensação febril, perda ponderal no período de 4 kg. Há 1 mês piora dor, há 3 dias náusea e vômitos Introduction: The use of mobile phones is increasing com procura por atendimento. No exame físico, worldwide. Mobile devices are becoming rapidly descorado, desidratado, abdome plano, levemente available and are being used as essential tools in tenso, dolorosa palpação região hipogástrica, sem promoting health, preventing disease and medical sinais de peritonite, toque retal sem fezes ampola, education. Objective: characterized mobile abaulamento parede posterior reto, mucosa lisa, sem applications (apps) used on mobile devices available sangue. Exames imagem, raio x de abdome - distensão on digital platforms that address topics about surgical cólon e delgado, tomografia - tumoração pélvica oncological. Methods: An exploratory research was comprimindo transição retossigmóide, sem plano de conducted in June 2019 on the iTunes App Store (Apple clivagem. Levantado hipótese de tumor retroperitoneal Inc, Brazil) and the Google Play Store (Google Inc, Brazil) (sarcoma) e devido quadro agudo de oclusão intestinal, using Lenovo Vibe K5 and iPhone 8 Plus mobile phones. paciente encaminhado procedimento cirúrgico - The term MeSH “Surgical Oncology” was applied. laparotomia exploradora com retossigmóidectomia + Qualified applications were initially selected and then enterectomia (invasão). O anatomopatológico, sugeriu downloaded for evaluation of functionality and quality e imunohistoquímica confirmou: neoplasia apresentava using the Mobile App Rating Scale (MARS). Results: 23 cm, invadia camada muscular do retossigmóide A total of 60 apps were found; two were excluded e ulceração íleal, identificado células redondas e (repeated). The category description identified 42 (70%) azuis, posteriormente imunohistoquimica presença books, journals, magazines, manuals, guidelines, or marcados positivos. Entre os diagnósticos diferenciais dictionaries. Medicine was the principal application area neoplasias abdominais infiltrativas como: linfoma de with 38 (63.3%) apps. Within this category, there has Hodgkin, rabdomiossarcoma e, principalmente, o tumor been significant annual growth since 2017. The inclusion desmoplásico de pequenas células redondas. O Linfoma criteria were the download frequency and publication de Burkitt, é subtipo raro, com características agressivas, time. The ten most downloaded applications from uma das neoplasias malignas com crescimento mais the previous two years were selected and evaluated rápido. Acomete predominantemente crianças. according to the MARS scale, and the average quality Embora a forma esporádica do LB seja algo incomum was between 3.0 and 4.75. Conclusion: Although there na população adulta (cerca de 1% dos linfomas), o is a lot of App in health, there are a minimal number paciente desse caso apresentou a doença aos 19 anos. of App for surgical oncology. The present study may O LB é preferencialmente tratado quimioterápicos e suggest the development of more adequate tools in corticoterapia, demonstra resultado satisfatório com this area, with the elaboration of new functionalities total remissão do tumor, em casos iniciais. A sobrevida and patient communication, which were absent in the nesses casos chega a 90% em 5 anos. O paciente do caso available applications. foi submetido a procedimento cirúrgico inicialmente, pela emergência da apresentação clínica, e não resposta Contato: Kleyton Santos de Medeiros ao tratamento clínico. Após confirmação patológica, foi [email protected] encaminhado a tratamento quimioterápico específico e segue com doença controlada.
TEMÁRIO: OUTROS E MISCELÂNIA Contato: Maurílio de Cássio Golineli CÓDIGO: 87689 [email protected]
Case Report: ACUTE OBSTRUCTIVE TEMÁRIO: OUTROS E MISCELÂNIA ABDOMEN-INITIAL CLINICAL PRESENTATION CÓDIGO: 87098 OF BURKITT‘S LYMPHOMA IN A YOUNG PATIENT CASO CLÍNICO DE PACIENTE COM METÁSTASE Autores: Maurílio de Cássio Golineli / GOLINELI, M. de PULMONAR DE MELANOMA EM VULVA C. / UNIVERSIDADE FEDERAL DA GRANDE DOURADOS ; Autores: Amanda Zampolli Feltrin / Feltrin, A. Z. / Raquel Esther Hermosilla Nunez / HERMOSILLA, R.E.N CEPON; Renan Deprá Camargo / Camargo, R. D. / / HOSPITAL UNIVERSITÁRIO DA GRANDE DOURADOS; CEPON; Daniel Di Pietro / Di Pietro, D / CEPON; Rafael Cláudio Germano Teodoro / TEODORO, C.G. / Vasconcelos / Vasconcelos, R. / CEPON; Jean Ricardo UNIVERSIDADE FEDERAL DA GRANDE DOURADOS; Silvestre / Silvestre, J. R. / HSJ. Caio Cezar Esqueapatti Sandrin / SANDRIN, C.C.E. / UNIVERSIDADE FEDERAL DA GRANDE DOURADOS. Melanoma de mucosa representa 1% de todos os melanomas. Acomete pessoas mais velhas, em média Paciente 19 anos, masculino, estudante, previamente 70 anos, enquanto melanoma cutâneo gira em torno hígido, encaminhado ao Hospital do Câncer de de 59 anos. Surgem, principalmente, em regiões da Dourados, MS, por um quadro abdome agudo cabeça e pescoço, anorretal e vulvovaginal (55%, 24% obstrutivo de causa tumoral. O paciente proveniente e 18% dos casos, respectivamente). Dos melanomas serviço hospitalar Urgência e Emergência da cidade,
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vulvovaginais, a localização mais comum é na vulva cases.However,the risk of postoperative complications seguido da vagina, com 95% e 3%, respectivamente. is more frequent in cancer patients,due to several Proporcionalmente, acomete mais negros, asiáticos e factors.The recognition and balance of these factors in hispânicos em comparação aos brancos. Alguns fatores the preoperative period is fundamental for the success de riscos que podem ser implicados são presença de of the treatment.Objective:To identify the risk factors nevos prévios, doença inflamatória crônica, infecções associated with the occurrence of surgical complications virais, irritantes químicos e fatores genéticos. V. B. P., in cancer patients operated at the General Hospital 78 anos, branca. Hipertensa, diabética e caridopata. of Cuiabá-MT.Method:retrospective cross-sectional Há 8 meses apresentou sangramento após fricção analytical study with the gathered information of 67 com papel higiênico na região de vulva. Realizou patients,who underwent on an oncologic surgery biópsia incisional que evidenciou melanoma de vulva between the months of July 2018 to February,2019. próximo ao clitóris. Realizado TC tórax e PET-CT após In the making of this study,the following variables o diagnóstico histológico que evidenciou nódulo were analyzed:age,gender,ASA(American Society of sólido pulmonar em lobo superior esquerdo de 1,3 x Anesthesiology),comorbidities,surgical data,Clavien- 1,1cm. Demais exames de estadiamento (ressonância Dindo and length of hospitalization.For the data analysis magnética pélvica, TC abdomen) sem anormalidades. and statistical tests,the program Epi Info(7.2.2.6) was Encaminhada para CEPON onde realizou vulvectomia e used.Results:The mean age of the patients was 52.9 segmentectomia pulmonar em LSE. Anatomopatológico: years (with a minimum age of 23 and a maximum age Vulva: espessura máxima 6mm. Ausência de ulceração. of 79),with the average length of hospitalization of Margens periférica e profunda livres (maiores que 24.83 ± 30.80(1 to 151 days).The gender survey showed 1,0cm). Índice mitótico 5mm². Clark IV. Pulmão: lesão em that 38(56, 72%) were female and 29(43.28%) were LSE infiltrado por neoplasia maligna pouco diferenciada male,establishing a ratio of 1.3:1.In total,34(50.78%) epitelioides. Margens livres. Linfonodos 5, 7 e 10 livres patients reported having comorbidities,with de neoplasias. O melanoma de mucosa apresenta hypertension appearing the most(40.30%)and pior prognóstico em relação ao melanoma cutâneo. 34(50.74%)presented a physiological disorder that went Enquanto a taxa de sobrevida global dos melanomas from mild to moderate (ASA-2).Relating to the surgery cutâneos gira em torno de 80% em 5 anos, o melanoma data,38(56.72%) were able to heal,27(40.30%) of them em mucosa é apenas 25%. Dados retirados do Banco de lasted less than 2hs,29(43.28%) with potential for Dados Nacional do Câncer dos Estados Unidos baseado contamination,10(14.9%) had some sort of complication na taxa de sobrevida em 5 anos de 223 mulheres and 5( 7.46%) had immediate complications.Regarding entre 1985 e 1989: estágio I 70%; II: 50%; III: 48%; IV: the postoperative period,18(26.87%) patients were 24%. Com isso, atenção especial tem de ser dada a admitted to ICU,12(17.91%) developed postoperative esses pacientes, pois além de comportamento raro e morbidity and mortality classified into(4 - Level III and de difícil diagnóstico, apresenta particularidades em 1 - Level IV),49(74.13%) were discharged in good health relação ao melanoma maligno cutâneo. Sendo assim, and 5(7.46%) died.The risk factors that were associated após diagnóstico histológico pode-se, então, direcionar with postoperative morbidity and mortality were length o tratamento e o seguimento. of hospitalization (RR = 3.5),immediate complications (RR = 5 , 5),type of surgery (RR = 3.4),ASA(RR = 2.0) and Contato: Amanda Zampolli Feltrin ICU(RR = 3.1).Conclusion:Despite the limitations in our [email protected] study related to the lack of information in the data as a whole,(which in this case,the lack of information also brings an important care alert),the results contribute to TEMÁRIO: OUTROS E MISCELÂNIA the awareness and comprehension of simple measures CÓDIGO: 88271 that can help to reduce postoperative morbidity and mortality,improving the care quality of the cancer COMORBIDITIES AND RISK FACTORS ASSOCI- patient. ATED TO POSTOPERATIVE COMPLICATIONS Contato: Izabel Nazira Nadaf IN SURGERIES OF CANCER PATIENTS [email protected] Autores: Izabel Nazira Nadaf / Nadaf, I. N. / UNIC ; Cleiton Ribeiro Lelis / Lelis, C. R. / UNIC- Universidade de Cuiabá; Rafaela Cassia da Cunha Pedroso / Pedroso, R. TEMÁRIO: OUTROS E MISCELÂNIA C. C. / UNIC- Universidade de Cuiabá; Rafaela Cardoso CÓDIGO: 88261 Do Nascimento / Nascimento, R. C. / UNIC- Universidade de Cuiabá; Raquel Maria Neves Amorim / Amorim, R. DESMOID TUMOR: CASE REPORT M. N. / UNIC- Universidade de Cuiabá; Polyana Silva Autores: Paulo Augusto Oliveira Cavalho de Goes / Lemes / Lemes, P. S. / UNIC- Universidade de Cuiabá; Goes, P. A. O. C. / Complexo Hospitalar São Francisco Jessica Proença Derze / Derze, J. P. / UNIC- Universidade de Assis; Priscilla Dias Silva / Silva, P. D. / Complexo de Cuiabá; Carla Joana Hugueney Franco Lobo / Lobo, Hospitalar São Francisco de Assis; Marcelo Vieira Gissoni C. J. H. F. / UNIC- Universidade de Cuiabá; Rosa Maria de Carvalho / Carvalho, M. V. C. / Complexo Hospitalar Elias / Elias, R. M. / UNIC- Universidade de Cuiabá; São Francisco de Assis; Diego Rolando Torrico Moscoso Gilmar Ferreira Do Espírito Santo / Santo, G. F. E. / UNIC- / Moscoso, D. R. T. / Complexo Hospitalar São Francisco Universidade de Cuiabá. de Assis; David Andrés Bravo Martinez / Martinez, D. A. B. / Complexo Hospitalar São Francisco de Assis; Introduction:Surgery is still the main treatment for Sergio Bernardo Torrico Moscoso / Moscoso, S. R. T. / cancer,and it is chosen do be done in more than 70% of Complexo Hospitalar São Francisco de Assis; Rodrigo
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Ralemadhá Gonçalves Rodrigues / Rodrigues, R. R. G. artéria ciliar, podendo levar à perda visual irreversível, / Hospital Vila da Serra; Nathalia Nascentes Coelho dos bem como à enucleação do globo ocular afetado. É rara Santos Omer / Omer, N. N. C. / Complexo Hospitalar São e representa entre 2 e 8% dos casos de endoftalmite. Francisco de Assis; Igor Dominick Michalick / Michalick, Objetivo Descrever um caso raro de complicação pós I. D. / Complexo Hospitalar São Francisco de Assis; operatória tardia em paciente portador de neoplasia Danilo Esteves Pires Filho / Filho, D. E. P. / Complexo de pâncreas. Relato de Caso: Homem de 84 anos Hospitalar São Francisco de Assis. submetido à duodenopancreatectomia em dezembro de 2016 por neoplasia de pâncreas. No oitavo dia de Introduction: The desmoid tumor originates from pós operatório apresentou febre e fístula biliar de baixo the fibroblasts of the muscle-aponeurotic tissues, has débito orientada por dreno de sump. Tratado com a high local growth capacity, causing adjacent organ Pipepraciclina e Tazobactam associado a octreotide com deformities, pain and eventually organic dysfunction. resolução da fístula em 7 dias. Em 23/12/2016 recebido Goal: Report the case of a woman diagnosed with a resultado de exame cultural de ponta de cateter central retroperitoneum desmoid tumor. Method: This is a positiva para Staphylococcus sp. Iniciou tratamento qualitative, observational study of a case report referring com Vancomicina de acordo com antibiograma com to a patient treated at the General Surgery Outpatient boa evolução. Iniciada quimioterapia com Gencitabina Clinic of the São Francisco de Assis Hospital Complex, por ADENOCA de pâncreas pT3, pN1, M0. Em maio located in Belo Horizonte-MG. Case Report: EADS, de 2017, apresentou dor ocular à direita, com supeita female, 40 years old, with left lower back pain radiating de herpes ocular. Fez nova avaliação oftalmológica to the left lower limb and palpable mass of hardened em julho por piora da dor sendo diagnosticado consistency and adhered to the iliac crest. Colonoscopy endoftalmite endógena. Exames investigação de was performed, which was incomplete due to significant endoftalmite, sem isolamento de bactéria. Realizada extrinsic compression with the biopsy showing demoid tratamento empírico com antibióticos sem melhora. fibromatosis. Magnetic Resonance Imaging showed Submetido em setembro de 2017 a enucleação de expansive, infiltrative, highly aggressive lesion involving olho direito. Resolução da dor após a cirurgia. Em several structures. Opted for surgical cytoreduction meados de 2018 apresentou recidiva da neoplasia e foi due to rising painful symptoms. During the surgical ao óbito em início de 2019. Discussão Pacientes com procedure, tumors of the abdominal wall invading the endoftalmite endógena bacteriana podem apresentar left iliac crest and abdominal cavity were identified. The sintomas de bacteremia ou apenas relatar dor ocular tumor was partially resected to an area of bone invasion e diminuição da visão. Doenças sistêmicas debilitantes that was unresectable. The descending colon, as well as como diabetes mellitus, neoplasias ou imunodepressão other abdominal organs were free and preserved. The são fatores de risco. As hemoculturas são o meio mais anatomopathological study of the lesion confirmed frequente de estabelecer o diagnóstico. Conclusão the desmoid tumor. Discussion: The desmoid tumor O relato envolve uma doença pouco comum na accounts for less than 3% of all soft tissue tumors, literatura, e seu diagnóstico e a rápida investigação are mostly slow growing, non-metastatic and locally do agente etiológico é de extrema importância para o aggressive. Signs and symptoms depend on tumor prognóstico do paciente. No caso relatado, não houve location, extent, mass size, and lesion growth rate. Local sucesso ao isolamento bacteriológico, com exames resection is the treatment of choice. Non-hormonal anti- de hemocultura negativos. A demora na suspeita de inflammatory drugs and estrogen receptor modulators endoftalmite endógena e a dificuldade diagnóstica e are considered first line in pharmacological treatment. terapêutica levou o paciente a um dos desfechos mais Conclusion: Abdominal mass has numerous etiologies. temidos - a enucleação do globo ocular. The importance of recognizing the characteristics of the desmoid tumor for early diagnosis stands out. Contato: Caroline Dalla Lasta Frigeri [email protected] Contato: Paulo Augusto Oliveira Carvalho de Goes [email protected] TEMÁRIO: OUTROS E MISCELÂNIA CÓDIGO: 87745 TEMÁRIO: OUTROS E MISCELÂNIA CÓDIGO: 87983 EPIDEMIOLOGICAL PROFILE, INDICATION, AND OUTCOME OF GASTROSTOMY PERFORMED IN ENDOFTALMITE ENDÓGENA SECUNDÁRIA À A HOSPITAL IN RIO GRANDE DO NORTE DUODENOPANCREATECTOMIA, UM RELATO Autores: George Alexandre Lira / Lira, G.A / Liga Norte DE CASO Riograndense contra o cancer ; Crislanny Regina Santos Autores: Marianna Bernardi Motta / Motta, M. B. / da Silva / Silva, C.R.S / Famene; André Luiz Costa e Silva Univates ; Caroline Dalla Lasta Frigeri / Frigeri, C. D. L. / / Silva. A.L.C / UNP; Isa Maryana Araújo Bezerra de Hospital Bruno Born - Univates; Guilherme de Campos Macedo / Macedo, I.M.A.B / UNP; Ivson José Almeida Adomingues / Domingues, G. C / Hospital Bruno Born. Medeiros Júnior / Junior, I.J.A / Famene; Vivian de Morais Nunes Teixeira / Teixeira, V.M.N / UNP. Introdução: Endoftalmite endógena é uma condição de inflamação ocular devido à infecção da cavidade Introduction: The first successful gastrostomy was intraocular por um êmbolo infeccioso proveniente completed on dogs in 1839 by Sedillott, whereas in de um foco distante no corpo que se espalha humans it was performed in 1876 by Verneuil. The hematologicamente pela artéria central da retina ou pela choice of the type of nutrition route will depend on
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the swallowing-related clinical conditions, the integrity Brasil; Leonardo Cardili / Cardili, L. / Instituto do Câncer of the gastrointestinal tract, and the general status of do Hospital das Clínicas da Faculdade de Medicina da the patient. Some indication of gastrostomy is the use Universidade de São Paulo, São Paulo, Brasil; André of enteral nutrition for a long time, which nasoenteral Roncon Dias / Dias, A. R. / Instituto do Câncer do Hospital or nasoenteric probes can cause complications such das Clínicas da Faculdade de Medicina da Universidade as migration or spontaneous removal, stenosis, and de São Paulo, São Paulo, Brasil; Bruno Zilberstein / tracheoesophageal fistula. Dysphagia is mentioned in the Zilberstein, B. / Instituto do Câncer do Hospital das literature as the main reason for gastrostomy indication. Clínicas da Faculdade de Medicina da Universidade de Objective: The propose of this article is to analyze the São Paulo, São Paulo, Brasil; Ulysses Ribeiro Jr / Ribeiro epidemiological profile, indications, and outcomes Jr, U. / Instituto do Câncer do Hospital das Clínicas da observed in gastrostomies performed in a hospital at Rio Faculdade de Medicina da Universidade de São Paulo, Grande do Norte. Methods: This is a nonrandomized São Paulo, Brasil; Evandro Sobroza de Mello / de Mello, retrospective review of medical records of patients E. / Instituto do Câncer do Hospital das Clínicas da undergoing surgical gastrostomy from January 2015 to Faculdade de Medicina da Universidade de São Paulo, January 2017, in a hospital in Rio Grande do Norte. For São Paulo, Brasil. theg analysis of the relationship between the variables, the chi-square test was used, adopting a significance level Background: Epstein-Barr virus (EBV)-positive gastric of 5% (p <0.05). Results: During this period, 144 patients cancer (GC) has been described as a morphologically underwent surgical gastrostomies. After evaluating the homogeneous subtype, especially associated with inclusion and exclusion criteria, was obtained a sample gastric carcinoma with lymphoid stroma (GCLS). The of 118 medical records. Men comprised 89 (74%) patients possibility that EBV+ GC had better prognosis and and women 31 (26%), with a majority over the age of 60 may be susceptible to immunotherapy has increased years (58.5%). 81.4% of the sample were smokers, and the interest in this subtype. However, the immune 63.6% were alcoholics. Discussion: Among the patients checkpoint and survival of EBV GC is still controversial, undergoing gastrostomies, 58% had head and neck especially with regard to GCLS and conventional EBV+ neoplasms, 31% esophagus, 4% stomach, 4% others, and gastric adenocarcinoma (GA). Objective: to evaluate 2% were not informed. Of these, 0.85% was in situ staging whether there are differences in clinicopathological of the disease, 9.32% stage II, 21.19% III, and 38.98% IV. characteristics and survival between EBV+ GC classified Complications related to the surgical procedure were as GCLS and conventional GA. We also investigated 20 cases (16.9%) and tube-related complications with the inflammatory response and PDL1 expression as 13 cases (11%). Besides, 57 patients (48.3%) were still potential marker for therapeutic indication. Methods: undergoing treatment, and 63 (53.4%) had the outcome we retrospectively evaluated a series of EBV+ GC of death. Conclusion: Surgical gastrostomy is a simple patients who underwent gastrectomy with D2- surgical procedure performed for over 100 years that lymphadenectomy. EBV positivity was determined by every general surgeon should be able to do. Attention in situ hybridization. MSI status, p16 and PDL1 were and care for the correct operative technique are essential evaluated by immunohistochemistry. GC was classified for good results. Furthermore, patients with malignant as GCLS or GA by histopathological evaluation. Results: neoplasms, if possible, should be operated earlier. This From a total of 30 EBV+ GC, 14 (46.7%) were identified did not prevail in our study, because more than 50% of as GCLS and 16 (53.3%) as GA (9 Intestinal, 6 diffuse, the sample was in stage III and IV, either due to access to 1 undetermined). Most patients were men (76.7%) health, late diagnosis of diseases. and had poorly differentiated histology (73.3%). There were no significant differences in age (p=0.926), Contato: andré luiz costa e silva gender (p=818), pN (p=0.732), pT (p=0.709) and pTNM [email protected] (p=0.895) between GCLS and GA. All cases had loss of p16 expression and MSI was present in 2 GCLS (p=0.209). PDL1+ was observed in 64.3% and 25% of TEMÁRIO: OUTROS E MISCELÂNIA GCLS and GA, respectively (p=0.030). The disease- CÓDIGO: 88237 free survival (DFS) was similar between LLGC and CA (71.4% vs 62.5%, respectively; p=0.632). When stratified EPSTEIN-BARR VIRUS-POSITIVE GASTRIC GA by histological type, Lauren diffuse GA had worse CANCER: CHARACTERISTICS AND PROGNOSIS survival than GCLS and intestinal GA (28.6% vs 71.4% vs OF A DISTINCT SUBTYPE OF DISEASE 88.9%, p=0.034). Also, DFS was better in patients with moderate/severe inflammatory infiltrate compared CANDIDATE FOR IMMUNOTHERAPY to GC with mild infiltrate, although without achieving Autores: Marina Alessandra Pereira / Pereira, M. A. / statistical significance (p=0.444). The main site of Instituto do Câncer do Hospital das Clínicas da Faculdade recurrence was lymph node/locoregional for GA (66.7%) de Medicina da Universidade de São Paulo, São Paulo, and distant recurrence (75%) for GCLS. Conclusion: Brasil; Daniel Molon / Molon, D. / Instituto do Câncer GCLS and GA EBV+ had similar characteristics and do Hospital das Clínicas da Faculdade de Medicina da different recurrence pattern. PDL1+ was associated with Universidade de São Paulo, São Paulo, Brasil; Marcus GCLS. Intestinal GA and GCLS had better survival than Fernando Kodama Pertille Ramos / Ramos, M. F. K. P. / diffuse EBV+ GA. These results suggest that specifically Instituto do Câncer do Hospital das Clínicas da Faculdade EBV+ GCLS may be prime candidates for PD1 directed de Medicina da Universidade de São Paulo, São Paulo, therapy and a better survival should not be attributed Brasil; Renan Ribeiro e Ribeiro / Ribeiro e Ribeiro, R. / to all GC EBV+. Instituto do Câncer do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Contato: Marina Alessandra Pereira [email protected]
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TEMÁRIO: OUTROS E MISCELÂNIA TEMÁRIO: OUTROS E MISCELÂNIA CÓDIGO: 87654 CÓDIGO: 87697
EXTRAGASTROINTESTINAL STROMAL EXTRANEURAL METASTASIS OF AN TUMOR PRESENTING AS A LARGE UPPER SIDE EPENDYMOMA: A CASE REPORT ABDOMINAL TUMOR TWO CASE REPORTS Autores: Sérgio Murilo Pereira da Silva Filho / SILVA FILHO, Autores: Vanessa Veronica Brocki Oliveira / BROCKI, S. M. P. / Liga Acadêmica de Oncologia do Hospital de Base V.V.O. / UNIRIO; Vitor Yu Zhu / ZHU, V.Y. / UNIRIO; Kaique do Distrito Federal; Beatriz Pires Paes / PAES, B. P. / Liga Torres Fernandes / FERNANDES, K. T. / UNIRIO; Beatriz Acadêmica de Oncologia do Hospital de Base do Distrito Escudeiro Nascimento / NASCIMENTO, B.E. / UNIRIO; Federal; Henrique Barbosa de Abreu / Abreu, Henrique Manuella Caroline Dutra Frazão Alves / FRAZÃO, M. C. Barbosa. / Liga Acadêmica de Oncologia do Hospital de D. A. / UNIRIO. Base do Distrito Federal; Beatriz Carneiro Habbema de Maia / MAIA, B. C. H. / Liga Acadêmica de Oncologia Man, 46 years old was admitted presenting abdominal do Hospital de Base do Distrito Federal; Anna Paula de pain for 6 months of increasing intensity, loss of weight Sousa Silva / SILVA, A. P. S. / Liga Acadêmica de Oncologia over 8 Kg, difficulty to eat and perception of a larger tumor do Hospital de Base do Distrito Federal; José Donato de intra abdominal. He had history of neurifibromatosis Sousa Netto / SOUSA NETTO, J. D. / Liga Acadêmica de with typical skin pigmentation. The CT scan showed Oncologia do Hospital de Base do Distrito Federal; Paulo solid 20 cm tumor, placed in retroperitoneum Henrique Rodrigues Correia / CORREIA, P. H. R. / Liga between the posterior gastric wall and the tail of Acadêmica de Oncologia do Hospital de Base do Distrito pâncreas, without adenopathies. No preoperative Federal; Bruno José de Queiroz Sarmento / Sarmento, B. J. biopsy was achieved. The laparotomy was proceeded Q. / Liga Acadêmica de Oncologia do Hospital de Base do em block R0 ressection of the tumor, body and tail Distrito Federal; Rodrigo Nascimento Pinheiro / Pinheiro, of pâncreas, spleen and linfonodes. Postoperative R. N. / Liga Acadêmica de Oncologia do Hospital de Base the paciente presented had a leakage of pancreas do Distrito Federal; Fernanda Penna Lima Guedes de resolved with non-surgical approach. Chemotherapy Amorim / Amorim, Fernanda P.L.G / Liga Acadêmica de was permormed with Imatinib Masylate. Woman, 83 Oncologia do Hospital de Base do Distrito Federal. years old was admitted for abdominal pain with back irradiation for a year, associated with nausea, vomit Case Report: A 36 - year old man, previously and loss of weight of 10 Kg, A CT scan showed a 30cm healthy. presented with intracranial hypertension tumor located in the gastrocolic ligament involving the syndrome: intense headache that started 2 months tail of pâncreas, without adenopathies. Preoperative ago associated with convergent squint and diplopia. transgrastric biospy endoscopic-guided showed a Brain MRI with contrast showed a right temporal gastrointestinal stromal tumor. I was proceeded parietal expansive lesion with a 12 mm deviation of neoadjuvant chemotherapy with imatinib mesylate the longitudinal fissure, subfalcine and transtentorial for 11 months achieving downstaging and release of herniation, suggestive of high grade neoplasic the pancreas. Was proceeded surgical ressection R0 lesion. The histopathological/ immunohistochemical of the tumor, without postoperative complications or diagnostic indicated a high grade glioma compatible adjuvante therapy. Although the GISTs represent less with anaplastic ependymoma. Patient received than 1% of all cancers, they are the most common adjuvant radiotherapy. 11 months after surgery, mesenchymal neoplasms of the gastrointestinal tract. presented with intense pain in lumbar region with GIST arises from the gastrointestinal pacemaker cells left leg irradiation and concomitant force reduction (Cajal Cells). Althought EGIST is identical in histological in the same member. Lumbar MRI showed diffuse and immunohistochemical features with GISTs, they infiltration of vertebras and tumoral extension to display no connection to the gut wall, representing muscle. Abdominal CT scan also showed lesions in 10% of the GISTs. Two immunohostochemical markers the pelvic bone. Finally, a biopsy of a lesion in the left are considered to be the most sensitive and specific: iliac bone confirmed metastasis of the ependymoma. KIT and DOG-1. Inhibitors of KIT and PDGFRa are Discussion: Ependymomas are ependymal cells options for a neoadjuvant or adjvant treatment, tumors, specific types of glial cells, originated from but the surgery is the only treatment leading to a the neuroectoderm, that arise within or adjacent potential cure. Regarding Immunohistochemestry, to the ependymal lining of the ventricular system . both of our patients showed the same scenary. The Ependymomas most commonly occur in the posterior patologial analyses of the case one tumor showed fossa, in contact with the fourth ventricle, or in the central necrosis with is a criteria of worse prognosis. intramedullary spinal cord, they ocasionally occur We reported a 2 rare presentations of EGIST, one in the brain parenchya outside the posterior fossa, neurofibromatosis type 1 related and the other was and very rarely outside the central nervous system undergone a neoadjuvant therapy with an excellent (CNS). Ependymomas account for less 10 percent of response. Altough its not frequent KIT mutation in tumors arising in the CNS. The metastatic occurrence NF1, they have a good response to imatinib. This may is rare, nevertheless metastasis cases were described be significant to strenghen the relationship between in adults in the following areas: lungs, cervical and the presence of the mutation and the use of imatinib hilar lymph nodes, skin, pleura, mediastinum, liver, therapy diaphragm and bones. Final comments: Anaplastic ependymoma case was related, in which the chosen Contato: Vanessa Veronica Brocki Oliveira treatment was resection of the tumor associated with [email protected] adjuvant therapy. The tumor evolved with metastasis
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to various locations with bone tissue, liver and muscle. TEMÁRIO: OUTROS E MISCELÂNIA The situation is a rare evolution to this type of tumor. CÓDIGO: 88066
Contato: Sérgio Murilo Pereira Da Silva Filho FREQUENCY ANALYSIS OF CANCER [email protected] DIAGNOSES AND MOST PREVALENT STAGING DURING EMERGENCY CARE AT A BELO TEMÁRIO: OUTROS E MISCELÂNIA HORIZONTE CANCER CENTER CÓDIGO: 87840 Autores: Rafael Barbosa de Santis / de Santis, R.B. / Faculdade CIências Médicas de MInas Gerais; FORMA PSEUDOTUMORAL DE ESQUIS- Lorena Araújo Salomão / Salomão, L.A. / Faculdade TOSSOMOSE EM LINFONODOS CERVICAIS, Ciências Médicas de MInas Gerais; Luísa Ribeiro MEDIASTINAIS E ABDOMINAIS Peixoto Henriques / Henriques, L.R.P. / Faculdade Ciências Médicas de MInas Gerais; Alberto Julius Alves Autores: Jéssica Lourenço dos Santos / Santos, J. L. / Wainstein / Wainstein, A.J.A. / Faculdade Ciências Unimed BH; Daciano Miranda / Miranda, D. / Unimed Médicas de MInas Gerais; Ana Paula Drummond-lage BH; Tulio Fernandes Assis / Assis, T.F. / Unimed BH; / Drummond-Lage, A.P. / Faculdade Ciências Médicas Frederico Nogueira Pereira / Pereira, F. N. / Unimed de MInas Gerais. BH. Introduction: Due to the increase in senility and Apresentação do caso: paciente sexo feminino, 42 risk factors exposure, cancer is currently the second anos, iniciou quadro de febre, hiporexia, perda de leading cause of death worldwide. This expansion in peso e linfadenomegalias múltiplas. Inicialmente, cancer incidence leads to a rise in the number of cancer apresentou linfonodo cervical, aderido a planos patients treated in emergency units. It is estimated profundos causando cervicalgia. Realizado exérese that during the disease, most patients experience de nódulo cervical esquerdo com anatomopatológico at least one emergency; being the symptomatology demonstrando processo inflamatório inespecífico, more frequent in advanced stages. In some cases, a abcedado. Realizado nova retirada de linfonodo cancer diagnosis is a consequence of emergency care. mediastinal por mediastinoscopia e novo linfonodo Objective: Analyze the frequency of cancer diagnosis cervical, com os mesmos achados anteriores. during emergency care and identify the most prevalent Realizado Pet scan, demonstrando linfonodo staging. Method: We performed a retrospective hipercaptante em tronco celíaco, ligamento gastro observational study, based on analysis of medical esplênico e linfonodo pré aórtico. Realizado records of the emergency unit of a UNACON, from Belo laparoscopia, evidenciado aumento de cadeia Horizonte, from July to December 2016. Data regarding linfonodal em tronco celíaco junto a artéria gástrica the diagnosis during hospitalization and tumor staging esquerda, aumento de cadeia linfonodal em grande were collected. Data were then submitted to statistical curvatura gástrica, presença de múltiplos nódulos analysis by software R, version 3.4.3. Categorical em superfície hepática. Realizado linfadenectomia variables such as n (%) sustain the results. Results: The em pequena curvatura gástrica em cadeias 3, 7, 8a, analysis of 214 records revealed that out of 36 patients 9, 12a. Optado por enucleação de nódulo hepático (13.95%) diagnosed during hospitalization, 15 (41.66%) e encaminhado peças ao anatomopatológico. O presented stage IV. Patients at stage IV totalized 113 exame histopatológico evidenciou esquistossomose (52.8%), while the initial stages (I to III) corresponded mansônica. Paciente recebeu alta da oncologia com to 19.63%; being 3 (1.4%) stage I; 13 (6.07%) stage II; coordenação de cuidados clínicos. Discussão: A and 26 (12.15%) stage III. The remaining 59 patients forma pseudoneoplasica da esquistossomose é (27.57%) were under investigation for staging at the conhecida como forma tumoral, tem interesse prático, time of hospitalization. Conclusion: The increase in embora seja pouco frequente, por simular uma symptomatology in advanced stages, as a consequence neoplasia maligna, pela sintomatologia obstrutiva of the natural history of the disease or treatment, is ou de compressão e pelo aspecto granulomatoso corroborated by the finding that 52.8% of patients had associado a consistência dura das lesões. Muitas stage IV. Totalizing 13.95%, diagnoses made during vezes, constitui achados cirúrgicos inesperados, hospitalization revealed a difficulty in identifying the podendo haver um ou vários tumores. Há excessiva disease by primary care, which makes the tertiary neoformação conjuntiva hiperplástica, devido à level of care essential for diagnosis. Late diagnoses resposta anômala aos elementos esquistossomóticos are related to worse clinical outcomes, making up a ou somente um conglomerado de ovos e granulomas. total of 41.66% of diagnosis during hospitalization. Comentários finais: esse relato demonstra a Thus, it is essential to adopt preventive and cancer relevância do diagnostico diferencial de tumorações control actions; reaffirming the role of primary care. e a necessidade de considerar esquistossomose, uma Professionals should be prepared to perform both vez que configura-se em uma das doenças de maior curative care and early detection and staging, enabling prevalência no Brasil. a more effective intervention.
Contato: Jéssica Lourenço dos Santos Contato: Rafael Barbosa de Santis [email protected] [email protected]
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TEMÁRIO: OUTROS E MISCELÂNIA TEMÁRIO: OUTROS E MISCELÂNIA CÓDIGO: 88375 CÓDIGO: 87533
GASTROINTESTINAL STROMAL TUMOR GIANT ADRENOCORTICAL CARCINOMA (GIST): A CASE REPORT RESSECTION WITH ENLARGED MERCEDES- Autores: Gabriel Sandim da Costa / Costa, G.S. / BENZ INCISION: A CASE REPORT Universidade Anhanguera-Uniderp; Rodrigo de Oliveira Autores: Filipe Vieira Kwiatkowski / KWIATKOWSKI, F. V. Pinheiro / Pinheiro, R.O. / Universidade Anhanguera- / Hospital do Rocio; Amanda da Silva Anjos / ANJOS, A. S. Uniderp; Ian de Oliveira Chaves / Chaves, I.O. / / Faculdades Pequeno Príncipe; Diego Carvalho Duarte Universidade Anhanguera-Uniderp; Lauren Umpierre Mari / MARI, D. C. D. / Hospital do Rocio; Brenno Giovanni Bernardi / Bernardi, L.U. / Universidade Anhanguera- Hernando Vidotti / VIDOTTI, B. G. H. / Hospital do Rocio; Uniderp; Karen Cavishini Rosseto / Rosseto, K.C. / Maikele Ertel / ERTEL, M. / Hospital do Rocio; Rafael Vieira Faculdade de Medicina de Marília; Vitoria Rosseti Kwiatkowski / KWIATKOWSKI, R. V. / Hospital do Rocio. Moreira dos Santos / Santos, V.R.M. / Universidade Anhanguera-Uniderp; Daniel Palomares Junior / Junior, Malignant neoplasm of adrenal cortex corresponds D.P. / Universidade Anhanguera-Uniderp. to 0.05 to 2% of all malignancies. Among the possible histopathological diagnoses, the most common are S.S.S, 56 years old, female. She was admitted to the Santa adrenocortical adenoma (52% of cases), adrenocortical Casa de Misericordia de Campo Grande Emergency Room carcinoma (12%) and pheochromocytoma (11%). from another Emergency Unit, reporting constipation Adrenocortical carcinoma is a rare neoplasm with associated with emesis, abdominal pain, fever and incidence ranging from 0.7 to 2 cases / million dysuria nine days ago. She denied return episodes and inhabitants / year, which predominates in females. We other complaints. On physical examination, the patient report a case of giant adrenocortical carcinoma, which presented regular general condition, globose abdomen, was resected using Mercedes-Benz enlarged incision. A with diffuse pain on superficial and deep palpation, 43-year-old female patient attended an oncology service especially in the epigastrium and left hypochondrium. with a history of abdominal distension, lower limb pain It was normotensive, normotympanic, watery airborne and vomiting in the 7 months prior to the consultation, noises, without visceromegaly or palpable masses. A with a weight loss of 31 kg. Denies alcoholism and computerized tomography scan of the abdomen showed smoking. Patient postmenopausal, with a grandmother the presence of collections suggesting abscesses, located with history of uterine cancer, using atenolol 25 mg. in the mesenteric fat, slightly to the right, and the other in On physical examination, palpable mass in the left the hypogastric region / right iliac fossa. An exploratory upper and lower quadrants of the abdomen, as well laparotomy was performed, in which the abscesses as bilateral 1+ / 4 + lower limb edema and 3 + / 4 + were removed, and a hemicolectomy was performed. petechiae. Chest computed tomography (CT) without The material was sent for biopsy and the result was abnormalities and abdomen showing splenomegaly the presence of a mesenteric intestinal stromal tumor and volumous expansive formation in the left renal (gastrointestinal stromal tumor - GIST) (free margins store, with apparent topography of the upper pole of / mitotic index <5). GIST originates from mutations in the left kidney (or in close contact with it), measuring Cajal interstitial cells, responsible for interstitial motility. about 22.7x20.5x20.1 cm in its larger diameters, Although rare, it is responsible for 80% of mesenchymal moving the remaining portions of the left kidney tumors of the TGI, most commonly occurring between the inferiorly, the pancreas superiorly and the aorta to the 5th and 7th decade of life and has a similar distribution right. Electrocardiogram (ECG) with no abnormalities between the sexes. Cajal cells express the receptor kit, and there was no significant increase in tumor markers. responsible for cell functions such as proliferation, The patient was admitted for exploratory laparotomy adhesion, cell differentiation, among other functions. in order to resect a possible pheochromocytoma Mutations that cause the activation of receptor tyrosine of the left adrenal gland, with enlarged Mercedes- kinase stimulated by the proto-oncogene KIT (CD-117) Benz incision. Left total nephrectomy was performed leading to the formation of GIST by triggering stimulus with left adrenalectomy and splenectomy. The for unbridled cell proliferation and apoptosis resistant. anatomopathological report of the piece found In general, GISTs are in the submucosa and muscle a congested spleen free of neoplasia and poorly proper of the affected organs and grow exophytic and/ differentiated neoplasia, widely necrotic and with diffuse or intraluminal way, leading to mucosal ulceration or dystrophic calcifications, affecting the adrenal and left obstructive processes. The most affected parts are- kidney, measuring 30x25 cm. Ascitic fluid collected stomach (55%), small intestine (25%) and colon (10%). during surgical procedure was negative for malignancy. They are often asymptomatic and occasionally diagnosed Immunohistochemical analysis of the specimen showed by imaging. The diagnosis is made through the clinical positivity for the markers synaptophysine, calretinin and picture, associated with imaging exams and histological alpha-inhibin, concluding that it was an adrenocortical study. Total tumor resection is the only method capable carcinoma infiltrating renal parenchyma. We consider of providing cure. Even though it is a rare and a few the description of this case important because of the known tumor, the correct approach to GIST is extremely low incidence of this type of tumor and the large size of important to determine the patients cure and, therefore, it, as well as the surgical technique used to improve the it is necessary to know more about this still little explored exposure of the surgical field. tumor. Contato: Amanda da Silva Anjos Contato: Rodrigo de Oliveira Pinheiro [email protected] [email protected]
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TEMÁRIO: OUTROS E MISCELÂNIA Female, 50 years old, investigating abdominal mass CÓDIGO: 87174 associated with lower limb edema and weight loss of more than 15%. Imaging exams, abdominal MRI, CT HANDMADE BAG FOR LAPAROSCOPIC abdomen, pelvis and thorax, USG TV showed large, SURGERY slightly heterogeneous, hypervascular solid mass, with moderate diffusion restriction and abdominopelvic Autores: Gustavo de Assis Gobetti / Gobetti, G. A. / macrolobular contours measuring about 22x20x13cm, Hospital do Câncer de Londrina; Marco Antonio Buges in addition to lymph node enlargement in the / Buges, M. A. / Hospital do Câncer de Londrina; José mediastinal region and nodule. basal region of the right D‘oliveira Couto Filho / Couto Filho, J. O. / Hospital do lung lower lobe measuring 1.4x1.0cm. Colonoscopy Câncer de Londrina; Francisco Carlos de Oliveira Lopes and EDA showed no significant changes. Opted for / Lopes, F. C. O. / Hospital do Câncer de Londrina; Maria surgical intervention. In the inventory of the cavity, Cristina Soubhia / Soubhia, M. C. / Hospital do Câncer abdominal tumors not adhered to other structures of de Londrina; Maria Cristina Bertan / Bertan, M. C. / exophytic growth were found, with areas of necrosis, Hospital do Câncer de Londrina; Bruno André Di Rico hypervascularization, vascular pedicles in the mesentery / Rico, B. A. / Hospital do Câncer de Londrina; Thiago root and abdominal wall. The mass in question was Astorga Martins / Martins, T. A, / Hospital do Câncer excised without affecting adjacent structures. It evolved de Londrina; Gilberto Tanno / Tanno, G. / Hospital do favorably in the postoperative period and was discharged Câncer de Londrina; Kelli Fernanda Pereira e Silva / at the 6th postoperative day. During outpatient Silva, K. F. P. / Hospital do Câncer de Londrina. follow-up, an anatomopathological examination was performed, showing a moderately differentiated Laparoscopic surgery is the best approach to many mesenchymal neoplasia of spindle and epithelioid cells, surgical pathologies. The removal of the cancer part compatible with the diagnosis of Hemangiopericytoma, should be done in a protected manner to decrease with surgical margins compromised by the disease. the rate of infection, part rupture or spread of cancer During follow-up, MRI showed nodular formations with cells to healthy tissue. There are commercial collector retrovesical heterogeneous signal in the adnexal region, scholarships in the market, with high costs, difficulty midline near the umbilical region and multiseptive in the release of use by medical agreements and their cystic formation in hepatic segment 6 associated absence in the public health system. Manual bag with segment 5 hypovascular nodules. A new surgical collection with affordable and available materials is a intervention was performed only with peritoneal biopsy positive alternative for use in laparoscopic surgery. for carcinomatosis. . Was discharged in the 3rd PO. It The technique of producing a bag made of soft and evolved in the late postoperative period with intestinal transparent material using the video cover made in subocclusion and death. Hemangiopericytomas are a the surgical field was developed immediately before rare malignant neoplasm that make up approximately the beginning of the surgery. A blind background knot 2% of soft tissue tumors, but difficult to determine due is made at the end of the video cover. It is important to the difficulty in collecting information. Although the that the knot is tight enough to allow material to enter incidence is difficult to measure, they are considered into 10mm trocar. Bevel cutting is performed with rare and make up only 2% of all soft tissue tumors. reinforcement of the edges with sterile microporous It is more common between the 5th and 7th decade tape followed by suturing in flat and tying the ends of of life, but can appear at any age, without gender the thread to each other. It is possible to estimate the differentiation. There are no known risk factors. final volume of the bag according to the expected to be The diagnosis is mainly made by exclusion, but with found, which is not feasible when making bags made the advent of immunohistochemistry it became with gloves. The diagonal cut (bevelled) is intended to possible to better identify this entity. The treatment is increase the area of entry to the bag, facilitating the basically surgical. This neoplasm is extremely rare and entry of the surgical part. The reinforcement allows unfavorable, and your best knowledge may help with increased traction at the time of removal of the piece, similar cases in the future. aided by suture, which allows the bag to close at the time of removal as well as prevents the bag from being Contato: Stefanie Sophie Buuck Marques opened with inadvertent traction of only one of the [email protected] threads. The collection bag made with video cover is easy to perform and presents satisfactory results in the retention of oncologic surgical specimens. TEMÁRIO: OUTROS E MISCELÂNIA CÓDIGO: 88266 Contato: Gustavo de Assis Gobetti [email protected] HEMIPELVECTOMIES AT HOSPITAL DE CLÍNICAS DE UBERLÂNDIA: A SERIE OF CASES TEMÁRIO: OUTROS E MISCELÂNIA Autores: Ana Júlia Marquez Pajuaba / PAJUABA, A. J . CÓDIGO: 87325 M. / UNIVERSIDADE FEDERAL DE UBERLÂNDIA ; Carla Aparecida Pinheiro / PINHEIRO, C. A. / UNIVERSIDADE HEMANGIOPERICYTOMA: CASE REPORT FEDERAL DE UBERLÂNDIA; Marcelo Bueno Pereira / PEREIRA, M. B. / UNIVERSIDADE FEDERAL DE Autores: Stefanie Sophie Buuck Marques / Marques, UBERLÂNDIA; Roberto Reggiani / REGGIANE, R. / S.S.B. / FMABC; Gian Carlo Vassoler / VASSOLER, G.C. UNIVERSIDADE FEDERAL DE UBERLÂNDIA; Tsbco Paulo / FMABC; Isabela Santas de Miranda / MIRANDA, I.S. / Henrique de Sousa Fernandes / FERNANDES, P. H. S. / FMABC; Rafael Martins Steffen / STEFFEN, R.M. / FMABC. UNIVERSIDADE FEDERAL DE UBERLÂNDIA; Tsbco Michel
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Jamil Chebel / CHEBEL, M. J . / UNIVERSIDADE FEDERAL A 69-year-old man presented with a consumptive DE UBERLÂNDIA; Tsbco Marcelo Augusto Faria de syndrome associated with abdominal pain and bulging. Freitas / FREITAS, M. A. F. / UNIVERSIDADE FEDERAL DE Abdominal tomography revealed a massive solid-cystic UBERLÂNDIA; Camila Leles Nascimento / NASCIMENTO, mass in the retroperitoneal region occupying left flank in C. L. / UNIVERSIDADE FEDERAL DE UBERLÂNDIA; Kelly close contact with the kidney, measuring 21.0x13.0x11.0 Martins Kawakami / KAWAKAMI, K. M. / UNIVERSIDADE cm. Similar right flank mass measuring 13.0x7.0x6.0 FEDERAL DE UBERLÂNDIA; Gustavo Braga de Faria / cm and hypogastric mass in contact with ileal loops FARIA, G. B. / UNIVERSIDADE FEDERAL DE UBERLÂNDIA. measuring 8.2x6.2x5.0 cm. The investigation was complemented by upper digestive endoscopy, which 1. Female, 18 years, diagnoses of giant cell tumor at revealed a high lesion in the second duodenal portion. left ileum, submitted to hemipelvectomy type I after We opted for a surgical approach, which included left neoadjuvant treatment. Evolved with metastatic colectomy, left nephrectomy, splenectomy, body-caudal implants in pelvis, submitted to rectosigmoidectomy, pancreatectomy, segmental enterectomies (30cm and hysterectomy, right salpingioophorectomy and 110cm from the Treitz angle), resection of right flank lymphadenectomy. 2. Male, 26 years, with eschar in tumor and terminal transver- sostomy. Patient evolved bilateral ischial tuberosity and progression to chronic satisfactorily and was discharged 7th postoperatively. osteomyelitis. Submitted to hemipelvectomy type II with Anatomopathological study showed results of samples resection of right ischium. 3. Male, 27 years, with trauma as origin of high grade malignant fibrohistiocytoma history in pelvic region, showed in a radiography lesion and result of immunohistochemical study pt4 p n0 in left hemipelvis. Biopsy evidenced chondrossarcoma pM1, histological grade G3, staging 4. Patient continued grade II. Submitted to hemipelvetomy type I + II. 4. outpatient follow-up at our service with the oncologic Female, 53 years, diagnoses of chondrossarcoma surgery and clinical oncology team , in which it was decided at left ilium, submitted to hemipelvectomy type I. 5. not to undergo chemotherapy treatment and start Male, 63 years, history of infected eschar and chronica palliative character to the case. Retroperitoneal tumors osteomyelitis in sacrum. Submitted to hemipelvectomy are malignant formations of low incidence (estimated at type III and resection of right femoral head associated 0.2 to 0.6% of all tumors) and with high rates of malignancy to osteosynthesis. 6. Male, 37 years, diagnoses of (about 85% of cases) and aggressiveness. Malignant chronic osteomyelitis at left ischiopubic ramus and fibrous histiocytoma is one of the retroperitoneal abductor muscle. Submitted to hemipelvectomy type neoplasms belonging to the subgroup known as soft III. 7. Female, 22 years, history of pain at the right hip tissue sarcoma, originating from mesodermal tissues. associated with tumor at the level of inguinal region, Its most frequently reported locations are in extremities Biopsy evidenced giant cell tumor, submitted to (50% of cases), retroperitoneum (40% of cases) and hemipelvectomy type III. Hemipelvectomy can be divided then head and cervical (10% of cases). A neoplasm as internal or external. The internal hemipelvectomy most commonly found in males and adulthood, with is indicated in cases of minor tumors, limited to one unspecific and insidious systemic clinical manifestations. hemipelvis, not compromising the lower limb or Usually diagnosed at an advanced stage, presenting few neurovascular structures. It can be divided in four types, curative chances. In cases with treatment possibility, the as proposed by Enneking: type I (iliac resection), type combination of surgical resection with chemotherapy is II (periacetabular resection), type III (púbis resection) indicated. The case in point is an extremely rare neoplasm, and type IV ( block resection of the hemipelvis). difficult to diagnose and poor in prognosis, requiring Furthermore, its commom the combination of types accurate diagnostic investigation and treatment as early II + III. The postoperative of the patients submitted to as possible. internal hemipelvectomy requires thromboprophylaxis cares, early limb mobilization and load between 60- Contato: Stefanie Sophie Buuck Marques 90 days. Most common complications include surgical [email protected] site infection, suture dehiscensce, fibulars graft release (when used to pelvic reconstruction), neuropraxy and thromboembolic events. Hemipelvectomies are large TEMÁRIO: OUTROS E MISCELÂNIA procedures, with important impact in patients life and CÓDIGO: 88164 require specialized and experienced surgical team, once surgical technic is complex and the risk of adverse LAPAROSCOPIC RETROPERITONEAL ADRE- events is high. NALECTOMY BY POSTERIOR PRONE POSI- TION APPROACH: INICIAL ACHIEVEMENTS Contato: Ana Júlia Marquez Pajuaba [email protected] Autores: Marciano Anghinoni / Anghinoni, M. / Hospital São Vicente; Mariana de Castro / Castro, M. de / Hospital São Vicente; Tiago Kuchnir / Kuchnir, T. / Hospital São TEMÁRIO: OUTROS E MISCELÂNIA Vicente; Priscila Nunes Silva Morosini / Morosini, P. N. CÓDIGO: 87324 S. / Hospital São Vicente; ágata Rothert / Rothert, A. / Hospital São Vicente; Fabio Roberto Fin / Fin, F. R. / HIGH GRADE RETROPERITONEAL FIBROHYS- Hospital São Vicente. TIOCYTOMA: CASE REPORT Introduction: The first laparoscopic retroperitoneal Autores: Stefanie Sophie Buuck Marques / Marques, adrenalectomy was proceed by Gagne, in 1992, and S.S.B. / FMABC; Isabela Santas de Miranda / MIRANDA, quickly became a popular technique and “The Gold I.S. / FMABC; Gian Carlo Vassoler / VASSOLER, G.C. / Standard” regarding the classics advantages related FMABC; Rafael Martins Steffen / STEFFEN, R.M. / FMABC.
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to the laparoscopic access. The retroperitoneoscopic old, white, married, teacher. In the last 6 months, pacient approach is a modern and not widespread way in our with high blood pressure, even in use of antihypertensive routine. The tchnique‘s standardization was due mainly drugs. Presenting also, palpitation, headaches, nausea, by former works of Waltz (1996), which demonstrated sweating, fatigue and weight loss. She performed the the feasibility of pneumodissection in this approach. following exams: Abdome Ultrasound that identified Objectives: the present study is a 3 cases report an oval, hypogenous, and with reduced vascularization of laparoscopic retroperitoneal adrenalectomy by mass on the topography of the left adrenal gland, posterior prone position approach and a critic review of measuring 5,8x5,8x4,5 cm; Abdominal Computed the literature. Methods: after the familiarization of the Tomography identifying a solid expansive lesion in the technique by the surgical oncology team, 3 cases was left adrenal gland, with oval shape and circumscribed selected. One patient with single melanoma metastasis contours, measuring 7.8x5.6cm, and with hyper vascular in right adrenal, one patient with metachronic enhancement after iodinated contrast infusion, as well metastasis of colonic cancer in right adrenal and one as tortuous and ectatic peripheral vessels to the lesion, patient with pheochromocytoma in left adrenal. The in addition, there was another solid retroperitoneal duration of surgery lasted between 90 and 120 minutes. expansive lesion to the left aortic, caudal to suprascribed There was no significant bleeding in post-operative adrenal lesion, with oval shape and circumscribed period. The pain was easily controlled with analgesics contours, with hyper vascular enhancement measuring (simple and opiods). All three patients was discharged 4.0x3.4cm, showing hypodense central component from hospital one day after the surgery. The literatures suggesting necrosis / liquefaction (as a diagnosis review shows that the technique is modern and not , interrogated pheochromocytoma and supra widespread. Also, presents some advantages: low adrenal paraganglioma); laboratory tests: urinary morbidity, less pain and quick post-operation recovery. metanephrines 15981 / 24h (RV 104-718), renin 498.2 The biggest obstacle for the popularization of the (RV 2.8-39.9) and dehydroepiandrosterone sulfate 93 technique has been the unfamiliar way of approach: the (RV 10-75). It was choosen for a surgical treatment, retroperitoneum, wich is well known by the urologists, tumor adrenal gland resection the surgery was made but not a routine for general and oncology surgeons. without any complications. The pathologist concluded Therefore, the technique requires specific learning metastatic pheochromocytoma, with necrosis present curve. Conclusion: The laparoscopic retroperitoneal and presence of hyaline globules. Patient with good adrenalectomy by posterior prone position is an postoperative evolution, remaining normotensive and excellent approach for the small pathologies of the without new paroxysms, even without antihypertensive adrenal gland. Although it is not a popular way of access medications. Conclusion: It was able to conclude that and it demands of familiarity, this approach is achiving the malignant pheochromocytoma, besides being rare, space as a minimally invasive alternative, with benefits have the diagnostic facilitated by the patients clinic, and compared with the usual laparoscopic way. if approached early, has effective surgical treatment.
Contato: Ágata Rothert Contato: Mariana Said Moreira [email protected] [email protected]
TEMÁRIO: OUTROS E MISCELÂNIA TEMÁRIO: OUTROS E MISCELÂNIA CÓDIGO: 87805 CÓDIGO: 88019
MALIGNANT PHEOCHROMOCYTOMA: CASE MÉNÉTRIER‘S DISEASE - CASE REPORT REPORT OF SURGICAL TREATMENT Autores: Eduardo de Biasio Milano / Milano, E. B. Autores: Mariana Said Moreira / Moreira, M. S. / / Centro Universitário Assis Gurgacz; Gabriel Brisot FAMEMA; Luis Gustavo Figols Rachella / Rachella, L. / Brisot, G. / Uopeccan; Julio Cesar Zanini / Zanini, G. F. / FAMEMA; Jaciene Rocha Nunes / Nunes, J. R. / J. C. / Uopeccan; Mariah Steinbach / Steinbach, M. FAMEMA; Georgia Lustre Terra / Terra, G. L. / FAMEMA; / Uopeccan; Tariane Friedrich Foiato / Foiato, T. F. / Mateus de Almeida Moreira da Silva / Silva, M. de A. Ceonc - Cascavel; Alessandra Parmegiani de Biasio / M. da / FAMEMA; Heloisa Mandolini Silva / Silva, H. Biasio, A. P. / Centro Universitário Assis Gurgacz; Luis M. / FAMEMA; Rafael Baldissera Cardoso / Cardoso, Fernando Gallina / Gallina, L. F. / Centro Universitário R. B. / FAMEMA; Vitor de Oliveira Lima / Lima, V. de Assis Gurgacz; Gustavo Alves Colombo / Colombo, G. A. O. / FAMEMA; Luciano Coelho Duarte / Duarte, L. C. / / Centro Universitário Assis Gurgacz; Tauana Friedrich FAMEMA. Foiato / Foiato, T. F. / Unicesumar; Janaina Gatto / Gatto, J. / Centro Universitário Assis Gurgacz. Goals: Describe successful surgical treatment of malignant pheochromocytoma, in a young pacient with Ménétrier‘s disease is categorized as a protein-losing difficult management of hypertension. Introduction: gastroenteropathy. It is a primarily benign disease Pheochromocytoma is a rare chromaffin cell tumor, with radiographic mimesis of malignant neoplasia. This cathecolamine producer, which can cause high blood disease has no reported incidence due to its rarity, pressure and the three symptons: sudden headache, but it is known to affect more children than adults, palpitations and sweating. The diagnosis is suggestive peaking at 2 to 5 years of age. It is usually triggered by when find increased urinary metanephrine and infections. Its pathogenesis is gastric hypertrophy which normetanephrine values, as well as imaging indicating is supposedly associated with increased epidermal tumor location. The treatment is based on tumor and growth factor due to the damage that pathogens adrenal gland resection. Pacient, S.A.P, female, 21 years cause in the gastric mucosa. The change is limited to
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the stomach and there are no signs of inflammation, em colonoscopia de rastreio, foi encontrada lesão intestinal metaplasia or dysplasia. Ménétrier‘s disease sugestiva de neoplasia maligna do ângulo esplênico do usually presents with nausea, vomiting, abdominal cólon, com biópsia confirmatória de adenocarcinoma pain and extremity edema. In childhood, the disease moderadamente diferenciado. A paciente foi submetida tends to be self-limiting, which resolves within weeks, à hemicolectomia esquerda e o AP detectou margens requiring only support. In adults, it is chronic and livres e linfonodos negativos, sem indicação de terapia severe, with very few cases of spontaneous remission. adjuvante. Paciente segue em acompanhamento The disease can occur in neonates and in most cases, oncológico cirúrgico e clínico. Discussão: O câncer fatal. The diagnosis is based on serum, imaging endometrial (CE) é a malignidade mais comum do and histological exams. The gold standard is upper trato reprodutivo feminino. As pacientes geralmente digestive endoscopy (EDA) with biopsy. Abdominal apresentam SUA e, em caso de doença avançada, dor ultrasonography demonstrates the preservation of abdominal e pélvica. Um dos fatores de risco para gastric wall stratification not present in lymphoma. The câncer uterino inclui o aumento dos níveis de estrogênio only known curative treatment for Ménétrier‘s disease (causado, entre outras coisas pela Síndrome de Lynch) is total gastrectomy. Treatments with prednisolone, e uso de tamoxifeno. A maioria dos CE é causada H2-antagonists, octreotide, NSAIDs and PH eradication por mutações esporádicas, mas mutações genéticas appear to be beneficial. Symptomatic treatment is hereditárias causam CE em cerca de 5% dos pacientes. based on PPI and albumin replacement. This is a case O rastreamento do tumor por reparo defeituoso of a 62-year-old white obese female patient who was de defeitos de DNA usando imunohistoquímica e referred to the surgery outpatient clinic in April 2019 for / ou instabilidade de microssatélites é usado para a vegetative gastric lesion in the gastric fundus region ,> identificar pacientes que devem passar por testes de 6 cm in length, observed in EDA for more than 2 years. rastreio para Síndrome de Lynch. Diante dos sítios years ago. Pathological examination (AP) of fundus tumorais acometidos da paciente, suspeitou-se da gland polyp associated with H. pylori infection. He Síndrome de Lynch tipo II (câncer colorretal associado referred to food vomiting and chronic use of PPI. She a neoplasias em outros órgãos, como de endométrio, has hypertension, diabetes mellitus and dyslipidemia ovário, mama, estômago, intestino delgado, sistema with a positive family history for esophageal CA. hepatobiliar, pâncreas, ureter e de pelve renal), no Former smoker. In a new EDA, she presented with a entanto, a paciente não tinha condições financeiras large villous vegetative lesion on the posterior wall of de fazer os exames necessários para diagnosticar a 5-7 cm; pathology resulting in chronic antrum gastritis síndrome, portanto, seguiu em acompanhamento and again presence of H. pylori. Abdominal ultrasound oncológico. Comentários Finais: Sendo assim, embora without particularities. The patient underwent surgical a relação entre ambos os tumores que acometeram resection of the lesion by laparotomy and intraoperative a paciente seja muito comum na síndrome de Lynch sample freezing, confirming the diagnosis of Ménétrier‘s tipo II, não foi confirmado esse diagnóstico devido aos disease. The patient evolved well postoperatively and altos custos para a paciente dos exames necessários. follows outpatient follow-up. The authors have no Porém, deve-se ressaltar a extrema importância do conflict of interest. acompanhamento desses casos para que seja possível fazer o diagnóstico e o tratamento precoces de novas Contato: Eduardo de Biasio Milano neoplasias que possam surgir. [email protected] Contato: Ícaro de Azevedo Alexandre [email protected] TEMÁRIO: OUTROS E MISCELÂNIA CÓDIGO: 87343 TEMÁRIO: OUTROS E MISCELÂNIA MÚLTIPLOS TUMORES PRIMÁRIOS - RELATO CÓDIGO: 87971 DE UM CASO MYOCARDIAL THORAX CARCINOMA - CASE Autores: ícaro de Azevedo Alexandre / Alexandre, REPORT I. A. / UFFS; Renata Bruna Garcia dos Santos Gatelli / Gatelli, R. B. G. S. / HCPF; Charles Nilton Gatelli / Gatelli, Autores: Eduardo de Biasio Milano / Milano, E. B. / C. N. / HCPF; Ana Paula Pompeu Vartha / Vartha, A. P. Centro Universitário Assis Gurgacz; Gabriel Brisot / P. / UPF; Cláudia Caroline Wentz Cardoso / Cardoso, C. Brisot, G. / Uopeccan; Mariah Steinbach / Steinbahc, M. C. W. / UPF; Keith Amanda Mann / Mann, K. A. / UPF; / Uopeccan; Julio Cesar Zanini / Zanini, J. C. / Uopeccan; Laurenlisiê Brittes / Brittes, L. / UPF; Naura Danieli Tariane Friedrich Foiato / Foiato, T. F. / Ceonc - Cascavel; Marcon / Marcon, N. D. / UPF; Leticia Signori Kohl / Kohl, Gustavo Alves Colombo / Colombo, G. A. / Centro L.S. / UFFS; Mariana Gregório / Gregório, M. / UFFS. Universitário Assis Gurgacz; Luis Fernando Gallina / Gallina, L. F. / Centro Universitário Assis Gurgacz; Apresentação do Caso: Paciente feminina, 60 anos, Alessandra Parmegiani de Biasio / Biasio, A. P. / Centro apresentou sangramento uterino anormal (SUA). Universitário Assis Gurgacz; Tauana Friedrich Foiato Embasado no exame clínico e de imagem, optou-se por / Foiato, T. F. / Unicesumar; Janaina Gatto / Gatto, J. / histerectomia, com diagnóstico no anatomopatológico Centro Universitário Assis Gurgacz. (AP) de adenocarcinoma endometrioide grau II e margens cirúrgicas livres de tumor. Foi indicado Myoepithelial carcinoma (CME) is a rare type of tratamento adjuvante e acompanhamento periódico tumor that mainly affects the salivary glands. It has com a oncologia clínica e cirúrgica. Após 4 anos, morphological, immunohistochemical, clinical and
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pathological aspects similar to other tumors, such Objective: To evaluate the pain of cancer patients as myoepithelioma, its benign variant, which makes treated at the Clinic of pain Nursing Clinic at a cancer its diagnosis difficult. The etiology is unknown. hospital in the state of Rio Grande do Norte. Method: The tumor manifests mainly in the salivary glands, This is a retrospective analytical study with a quantitative predominantly in the parotid, corresponding to 0.2% of approach, had variables dependent on the pain of the all tumors of these glands. There is no predominance oncologic patient and independent variables the data of gender or ethnicity or great variability in relation of the clinical evaluation obtained during the nursing to age. The clinical behavior of this disease tends to consultation and the drug therapy used in the control be aggressive. Diagnostic confirmation of this disease of cancer pain. We obtained a waiver from the Research requires combinations of histopathological features Ethics Committee to sign the Free and Informed Consent and corroborating immunohistochemical profile. The Term, considering that the research was performed with treatment strategy still remains without consensus. secondary data from patients‘ records that are regularly Safe margin surgical exeresis with optimized adjuvant treated at the Nursing Clinic of Pain. Results: A total of chemotherapy offer better survival outcomes. 50 patients were treated at the outpatient clinic of the Radiotherapy can be used to prevent local recurrences. pain clinic. With sociodemographic data, 54% were alive The CME becomes even more complicated in relation and 46% had already died. Male people with 66% and to management and diagnosis because it can present female audience with 34%. Of this population, only 1% varied presentation sites, such as the case reported. presented as a predisposing factor Diabetes Mellitus. Male patient, 76 years old, former smoker, referred to The hypertension factor was 11% and 3% presented the cancer hospital in April 2019 for splenomegaly. He both comorbidities. Among the neoplasms, prostate referred right chest pain for 2 months, asthenia and neoplasms were recorded with 37%, oral cavity 4%, lung weight loss of 10 kg in 2 years. Brought with him Full 10%, breast 8%, head and neck neoplasias 20%, cervix abdomen tomography showing bone lesion suggestive 6% and neoplasias of ovary, multiple myeloma, colon, of secondary implantation in the right costal arches, rectum, skin, renal, gastric a representation of 2% each. abdominal lymph node enlargement, signs of chronic It has been observed that the time of onset of pain has liver disease and splenomegaly. No findings suggestive varied according to its diagnoses being in average from of primary neoplastic site. On physical examination, a 1 to 3 years, being characterized as continuous or comes 4.5 x 7 cm lower right costal mass was palpated. New and goes independently of something, interfering in its chest and total abdominal CT scans revealed mediastinal activities. There was a variation in the intensity of the lymph node enlargement and right hilar; vegetating pain, being represented by 40% with category 4, 20% in lesion in the rectosigmoid transition, suggestive of category 5, category 7 with a total of 10% and the other primary neoplasia; bone injury in the eighth costal 20% were distributed among the other levels of pain. arch suggestive of secondary injury. Suspected Among the drugs used during the evaluation in the metastatic colon cancer, costal nodule resection pain clinic the ones that stood out the most were the suggested for analysis. Performed biopsy we obtained weak opioids, representing a total of 74% and 26% were anatomopathological result of mesenchymal neoplasia, representing with the strong opioids. The management suspected chondrosarcoma; Immunohistochemistry and evaluation of the nursing team in front of the compatible with myoepithelial carcinoma. Patient patient in the pain clinic, allowed in both cases, better continues to investigate new primary colon, awaiting control of pain, as well as information about the colonoscopy and enlargement of immunohistochemical guidelines needed for the cancer patient. Conclusion: panel seeking possible diagnoses of Castleman‘s The multiprofessional project in Oncology provided a disease, lymphoproliferative or GIST. The authors have better quality of life and dignity in the treatment and no conflict of interest. follow-up of cancer patients.
Contato: Eduardo de Biasio Milano Contato: Kleyton Santos de Medeiros [email protected] [email protected]
TEMÁRIO: OUTROS E MISCELÂNIA TEMÁRIO: OUTROS E MISCELÂNIA CÓDIGO: 87973 CÓDIGO: 87147
NURSING CARE IN THE EVALUATION OF POORLY DIFFERENTIATED INVASIVE AD- MULTIDIMENSIONALITY OF ONCOLOGICAL ENOCARCINOMA IN THE DISTAL ILEUM: PAIN CASE REPORT Autores: Simara Silva Alves / ALVES SS / Liga Contra o Autores: Rafael Fontana / Fontana, R / Hospital Geral Câncer; Fernanda Beatriz Batista Lima e Silva / SILVA de Caxias do Sul; Fernando de Marco dos Santos / FBBL / Liga Contra o Câncer; Patrícia Cristina Pascoto de Santos, F.M / Hospital Geral de Caxias do Sul; Fernando Moura / MOURA PCP / Liga Contra o Câncer; Weruska dos Santos Bitencourt / Bitencourt, F.S / Hospital Geral Alcoforado Costa / COSTA WA / Universidade Federal de Caxias do Sul; Mariana Gabriela Mandelli / Mandelli, do Rio Grande do Norte; Kleyton Santos de Medeiros M.G / Hospital Geral de Caxias do Sul; Camila Barbosa / MEDEIROS KS / Universidade Federal do Rio Grande Saueressig / Saueressig, C.B / Universidade de Caxias do do Norte. Sul; Marília Caroline Breyer / Breyer, M.C / Universidade de Caxias do Sul; Carolina Matté Dagostini / Dagostini, Introduction: Cancer pain adds up to several aspects, C.M / Universidade de Caxias do Sul; Bruna Lucchese basing it on the emotional, social, and spiritual Meinerz / Meinerz, B.L / Universidade de Caxias do Sul; consequences of exposure to pain experience. Eduardo Pohlmann Filho / Filho, E.P / Universidade de
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Caxias do Sul; Jéssica Salua Pasquetti / Pasqualetti, J.S / Henrique Camilo Martins da Costa / Costa, H.C.M. / Universidade de Caxias do Sul. Oncobio; Gustavo Guerra Jacob / Jacob, G.J. / Oncobio.
Case Presentation: A 59-year-old female smoker, with The use of implantable ports is very common and no other comorbidities, sought treatment for arrest of important in the treatment of oncological patients. flatus and feces elimination for 6 days associated with They are a more practical and comfortable way of severe abdominal pain. Computed tomography without drawing blood, and give intravenous chemotherapy , abdominal contrast showed a tumor located in the distal blood transfusions and other drugs. Mostly, they are ileum associated with numerous continuous lymph implanted in the subclavian or jugular veins, with the nodes to the lesion, leading to an obstructive condition. port itself placed in the upper torso. Alternatively it can In the hepatic segment V, a 35 mm nodule was suspected be placed in the basilic vein , with the port placed in of secondary neoplastic implant. Patient referred for a brachial position. This option has gained popularity exploratory laparotomy. The abdominal cavity inventory among physicians and patients in recent years. We showed the presence of ulcero-vegetating lesion in the present a multidisciplinary multi institutional study distal ileum with lymph node enlargement to the root of in patient quality of life, satisfaction with the port the mesentery and evidence of solid palpation injury in and practical use of them by health care providers. the hepatic segment V compatible with the tomographic Approximately, one third of all porth-a-caths in the study findings. Enterectomy with lymphadenectomia was were placed in a brachial position, with no significant performed to the superior mesenteric artery with diferences in complication rates. Evaluating the nursing primary reconstruction of the traffic with end-to- staff experience , there is a slight preference towards end anastomosis. Anatomopathological examination the brachial position , primarily because o s patient showed the presence of poorly differentiated invasive positioning and exposure. Quality of Life evaluation adenocarcinoma in the distal ileum with infiltration was done by a questionnaire delivered to and filled by into adipose tissue and angiolymphatic tissue with patients, showed great acceptance , with less limitations lymph node metastasis and free surgical margins. to daily activities, and less aesthetic impact. the majority Staging tests showed a single nodular formation in of patients would suggest this approach to future the hepatic segment V, compatible with a secondary patients. Concluding, brachial port-a-caths in the basilic implant. Patient was discharged from hospital with vein is a feasible and interesting option for patients in surgical treatment planning for liver metastasis. In the oncologic treatment, and might be considered as first intraoperative period, 4 months after the first surgery, line option in institutions in which protocols can be liver palpation revealed subcapsular nodules of random implanted to this regard. distribution of about 5 mm, which made it impossible to completely remove the lesions. Postoperative Contato: Jairo Cequeira de Almeida Teixeira evolution was excellent and the patient was referred for [email protected] systemic treatment with chemotherapy. Discussion: Small bowel neoplasms are extremely rare. Distance disease is the leading cause of death in this type of TEMÁRIO: OUTROS E MISCELÂNIA cancer. Information on metastasectomy for small CÓDIGO: 87163 bowel adenocarcinoma is limited. Once it is generally a safe procedure, indications for liver resections of non- PRIMARY NEUROENDOCRINE TUMOR OF THE colorectal and non-neuroendocrine primary tumors SPLEEN: CASE REPORT have been increasing in recent years. Final comments: Our case demonstrates the importance of distant Autores: Mariana Geraldi Rodrigues / Rodrigues, M. G. / disease screening for small bowel neoplasms and raises Universidade do Vale do Itajaí - UNIVALI; Mohamad Read a reflection on the approach to distal ileum neoplasms, / Read, M. / Hospital e Maternidade Marieta Konder exploring metastasectomy as a therapeutic option with Bornhausen - HMMKB; Fernanda Gonçalves da Silva / favorable outcomes. Silva, F. G. / Universidade do Vale do Itajaí - UNIVALI; Fernanda Fossa Dal Piva / Dal Piva, F. F. D. / Universidade Contato: Fernando dos Santos Bitencourt do Vale do Itajaí - UNIVALI; Gabriela Aparecida Schiefler [email protected] Gazzoni / Gazzoni, G. A. S. / Universidade do Vale do Itajaí - UNIVALI; Gustavo Galvan Debiasi / Debiasi, G. G / Hospital e Maternidade Marieta Konder Bornhausen TEMÁRIO: OUTROS E MISCELÂNIA - HMMKB; Giovanna Folle Moschetta / Moschetta, G. CÓDIGO: 87201 F. / Universidade do Vale do Itajaí - UNIVALI; Lucas Viechniewski Vasconcellos / Vasconcellos, L. V. / PORTH-A-CATHS IN BRACHIAL POSITION Universidade do Vale do Itajaí - UNIVALI. - MULTIDISCIPLINARY EXPERIENCE AND Case Report: Male, 39 years old, complaining of PATIENT SATISFACTION progressive and compressive abdominal pain in the left Autores: Jairo Cerqueira de Almeida Teixeira / hypochondrium, for 2 years ago and worsening for the teixeira,J.C.A. / OncoBio; Jairo Cerqueira de Almeida last 6 months ago, due to enlargement of the abdominal Teixeira / Teixeira, J.C.A. / Oncobio; Daniella Francisco region causing dyspnea. Chronic renal patient on dialysis, Pinto Ribeiro / Ribeiro, D.F.P. / OncoBio; Barbara Ribeiro hypertensive and with previous bone marrow biopsy Campolina Araujo / Araujo, B.R.C.A. / OncoBio; Claynner which suggest hypercellularity for the age, with alterations Paccely Oliveira Bessa / Bessa, C.P.O. / Oncocentro; pointing to chronic myeloproliferative disorder. Laboratory tests showed pancytopenia and significant renal changes.
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Abdominal ultrasound (USG) showed accentuated foi realizada ultrassonografia de abdome, identificando splenomegaly, enlarged liver associated with portal and um nódulo misto em hipocondrio direito a esclarecer, splenic vein ectasia and presence of free fluid in the upper (interrogado pelo ultrassonografista neoplasia primária abdomen. Abdominal tomography confirmed findings ou metastática). Nega queixas álgicas, nega nauseas described in the US. After hematological evaluation, it ou vômitos, hábitos fisiológicos preservados . Nega was decided to perform total open splenectomy with pre emagrecimento ou dor local. abdome plano, indolor à and postoperative prophylaxis for encapsulated germs. palpação, sem sinais de irritação peritoneal, presença The anatomopathological analysis showed solid epithelial de massa dura, indolor , não movel, em Hipocondrio neoplasia involving periosplenic ductal tissue and absence direito e flanco direito. TC de abdome , pelve e tórax of peri-splenic lymph node disease. Immunohistochemistry demonstrando lesão em hipocôndrio, flanco dir. com confirmed the diagnosis of neoplasia, positive for the íntima relação com ureter direito, rim direito e veia synaptophysine and chromogranin antibodies indicating cava. sem evidências de metástases ou outras lesões. the neuroendocrine differentiation of neoplastic cells, Paciente submetida em 27/04/2018 a ressecção being low grade neuroendocrine neoplasia (NET 1). higiênica de neoplasia de partes moles paravertebral. Discussion: Neuroendocrine Tumors (NET) are so- Ato complicado com sangramento moderado por called because they characterize a group of rare tumors dissecção intima com veia cava e artéria ilíaca. Deixado originating from hormone-producing cells of the 02 drenos de penrose, sentinela em loja tumoral. endocrine system. Determined to be heterogeneous and Paciente apresentou boa evolução, recebendo alta 5 dias slow growing, they affect almost all organs, predominating após procedimento Anatomopatológico: 27/04/2018: in the gastrointestinal tract (60%) and respiratory tract consistente com neoplasia de origem neural, compatível (25%). INCA estimates 5.25 new cases per 100 thousand com SCHWANNOMA Nova laparotomia em 11/01/2019, inhabitants, with prevalence in the sixth and seventh não sendo observadas evidências de lesões em decade of life. NET may be an incidental finding, as retroperitêoneo Tc abdominal total 14/01/2019: sem symptoms are nonspecific, depending on their location evidências de lesão neoplásica controle trimestral em and hormone production. Carcinoid syndrome may ambulatório, paciente mantendo-se assintomática, e occur, characterized by facial flushing, abdominal pain, sem sinais radiológicos de recidiva até última consulta and diarrhea, usually with liver metastasis. To decide on Discussão: Schwannomas raramente ocorrem no the treatment, imaging and biopsy are performed, which retroperitôneo, sendo responsáveis por 1% a 10% de will confirm the diagnosis by identifying if there is local todos tumores retroperitoneais, sendo que apenas lymphadenopathy and determining the proliferation cerca de 3% de todos Schwannomas se localizam em index (Ki-67). Final considerations:Thus, it was defined retroperitôneo. Schwannomas retroperitoneais (SR) as primary spleen NET, as there are no cases described podem atingir tamanhos consideráveis , rechaçando in the literature that support this report. The patient of e por vezes invadindo estruturas adjacentes, de forma the case in question is being followed up with no signs of que os quadros iniciais são comumente assintomáticos, return of tumor activity. e à partir do momento em que a lesão exerce efeito de massa sobre outras estruturas, o paciente pode Contato: Mariana Geraldi Rodrigues apresentar sintomas vagos e inespecíficos, dificultando [email protected] o diagnóstico precoce. Comentários finais: O caso acima descrito, demonstra um achado incidental de schwannoma retroperitoneal em paciente TEMÁRIO: OUTROS E MISCELÂNIA assintomática ,sendo que a íntima relação com CÓDIGO: 87770 estruturas nobres impediu a ressecção completa, mas devido a mecanismos não elucidados houve regressão RELATO DE CASO : REGRESSÃO ESPONTÂNEA espontânea do tumor em pós operatório tardio DE SCHWANNOMA PÓS RESSECÇÃO Contato: Marcelo Vieira Gissoni de Carvalho HIGIÊNICA [email protected] Autores: Igor Dominick Michalick / Michalick, I.D / Complexo hospitalar São Francisco de Assis; Marcelo Gomes Girundi / Girundi, M.G / Complexo hospitalar São TEMÁRIO: OUTROS E MISCELÂNIA Francisco de Assis; Marcelo Vieira Gissoni de Carvalho / CÓDIGO: 88044 Carvalho, M. V. G / Complexo hospitalar São Francisco de Assis; David Andrés Bravo Martínez / Martinez, D. RETROPERITONEAL SOLITARY FIBROUS A. B. / Complexo hospitalar São Francisco de Assis; TUMOR - CASE REPORT AND LITERATURE Priscilla Dias Silva / Silva, P. D. / Complexo hospitalar REVIEW São Francisco de Assis; Amanda Cristina Torres Martins Bicalho / Bicalho, A. C. T. M / Complexo hospitalar São Autores: Luciana Mata da Silva / Mata, L.S / Hospital de Francisco de Assis; Danilo Esteves Pires Filho / Pires, Câncer de Pernambuco; André Luiz Marques Marinho D. E. F. / Complexo hospitalar São Francisco de Assis; / Marinho, A.L / Hospital de Câncer de Pernambuco; Paulo Augusto Oliveira Carvalho de Goes / Goes, P. A. O. Cecília Araújo Carneiro Lima / Lima, C.A.C / Hospital de C / Complexo hospitalar São Francisco de Assis; André Câncer de Pernambuco; Mario Rino Martins / Martins, Rennó Coelho / Coelho, A. R. / Complexo hospitalar São M.R / Hospital de Câncer de Pernambuco; Ingrid Kelly Francisco de Assis. de Lima Cavalcanti / Cavalcanti, I.K / Universidade Maurício de Nassau; Aline Batista de Castro / Castro, Paciente: CCPS , 36 anos , sexo feminino, Encaminhada A.B / Universidade Maurício de Nassau. em 15/04/2018 ao ambulatório de cirurgia oncológica da instituição com relato de que: em avaliação de rotina ,
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Case Report: Male, 73 years old, complaining of / Centro Universitário Assis Gurgacz; Tauana Friedrich constipation and dysuria for 10 months, associated Foiato / Foiato, T. F. / Unicesumar. with discomfort in the hypogastrium and loss of 3% of body weight. In the physical exam, he presented a Pheochromocytomas / paragangliomas are tumors massive, hardened mass fixed in the lower abdominal derived from tissues coming from the neural crest wall. In the rectal touch, it could be detected a bulg chromaffin cells and can be found anywhere in which in the left anterior and lateral walls, extrinsic to the there is an autonomic nervous system. These are rectum, starting 3 cm from the anal margin with 6cm rare tumors usually occurring in 2 to 8 individuals per of extension. Magnetic resonance imaging showed a million annually. The most common topography is in well-vascularized lesion of 17 cm, which was anteriorly the adrenal medulla (85%), being pheochromocytomas. pushing the rectosigmoid and bladder, in addition Paragangliomas are found at extra-adrenal sites such to several oval masses with signal intensity and as the Zuckerkandl organ, the urinary bladder, the heterogeneous enhancement. The patient underwent a chromaffin cells of the autonomic ganglia in the neck, percutaneous radio-intervention biopsy with pathology chest, and abdomen. This tumor may have a familial and immunohistochemistry showing low-grade spindle origin, usually presenting as bilateral or multifocal cell proliferation with hemangiopericytic pattern and CD masses at a younger age. Both pheochromocytoma 34 +, CD 99, BCL 2+, concluding as Solitary Fibrous Tumor and paragangliomas may secrete catecholamines, but (SFT). Due to the extension of the lesion, in which the only the adrenaline secreted pheochromocytoma. Most suggested surgery would be a total pelvic exanteration, of these tumors are benign in character. However, it was chosen to initiate neoadjuvant radiotherapy, with paragangliomas metastasize in about 20 to 42% of cases similar dose for sarcoma. However, the tumor did not in relation to pheochromocytomas, which have a 2 to regress, although the patient remains asymptomatic. At 10% incidence of metastases. The patient‘s clinic is based this time, he refuses surgical treatment, remaining in on the consequences of excess catecholamine release outpatient follow-up. Discussion: SFT is a mesenchymal in the circulation, having the classic triad of episodic spindle cell neoplasm, first recorded in 1931. It has no headache, sweating and palpitations, among other gender preference, nor does it have environmental risk symptoms. The diagnosis is made by the concentration factors and affects adults more often between sixty of plasma metanephrines. Imaging studies localize the and seventy years of age. The most common location tumor with high sensitivity and specificity, but are not is intrathoracic, followed by intra-abdominal, and the sensitive to tumors <2 cm. To locate small masses, rare retroperitoneal, with less than 100 related cases. It Imetaiodobenzylguanidine (I-MIBG) scintigraphy is has an average size between 7 and 10 cm and can vary used for more accurate staging. The treatment of this from 1 to 40 cm, producing symptoms due to mass in condition is essentially surgical and seen as the only other organs. The diagnosis is historical with presence dressing. The risk of surgery is the management of the of spindle cells and prominent vascularization, aided tumor to remove it, which can trigger an exacerbated by immunohistochemistry (CD 34 expressed in 79% catecholamine secretion leading to hypertensive crisis, of cases). Most SFT are benign, only 10% to 20% of arrhythmias and acute myocardial infarction. Thus tumors have malignant behavior, which have high preoperative preparation for this surgery is essential. recurrence (63%). Treatment and follow-up are still not The case of the study is based on a 53-year-old white, well defined, following, in most cases, the guidelines for hypertensive, asthmatic man, referred in May 2019, to soft part sarcomas. Final considerations:The scientific the left retroperitoneal abdominal surgery outpatient relevance of this report lies in the rarity of the case clinic. Abdominal tomography showing mass with soft presented, especially in the malignancy and infrequent tissue density in the left para-aortic region measuring location. And, consequently, the lack of publications 4.5 x 4.3 cm. No history of cancer in the family. Submitted and guidelines related to the treatment and follow-up complete resection of the lesion. Pathology showed that of the exposed theme, contributing to portray the lack it was a neoplasm with neuroendocrine characteristics; of response of neoadjuvant radiotherapy. Immunohistochemistry (IHC) matched the tumor as a paraganglioma. Patient follows outpatient follow-up, Contato: André Luiz Marques Marinho with no signs of relapse. The authors have no conflict [email protected] of interest.
Contato: Eduardo de Biasio Milano TEMÁRIO: OUTROS E MISCELÂNIA [email protected] CÓDIGO: 87931
RETROPERITONIAL PARAGANGLIOMA - CASE TEMÁRIO: OUTROS E MISCELÂNIA REPORT CÓDIGO: 88200 Autores: Eduardo de Biasio Milano / Milano, E. B. / THE ASSOCIATION BETWEEN SURGICAL RISK Centro Universitário Assis Gurgucz; Gabriel Brisot / Brisot, G. / Uopeccan; Mariah Steinbach / Steinbach, SCORES AND LENGTH OF HOSPITALIZATION M. / Uopeccan; Julio Cesar Zanini / Zanini, J. C. / OF PATIENTS UNDERGOING CANCER Uopeccan; Tariane Friedrich Foiato / Foiato, T. F / Ceonc SURGERY IN A TEACHING HOSPITAL IN MATO - Cascavel; Luis Fernando Gallina / Gallina, L. F. / Centro GROSSO Universitário Assis Gurgacz; Gustavo Alves Colombo / Colombo, G. A. / Centro Universitário Assis Gurgacz; Autores: Rafaela Cassia da Cunha Pedroso / Pedroso, R. Janaina Gatto / Gatto, J. / Centro Universitário Assis C. C. / UNIC- Universidade de Cuiabá; Izabel Nazira Nadaf / Gurgacz; Alessandra Parmegiani de Biasio / Biasio, A. P. Nadaf, I. N. / UNIC- Universidade de Cuiabá; Cleiton Ribeiro
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Lelis / Lelis, C. R. / UNIC- Universidade de Cuiabá; Rafaela Alexandre Mio Pos / Pos, A.M. / Faculdade Ciências Cardoso Do Nascimento / Nascimento, R. C. / UNIC- Médicas de Minas Gerais; Mateus Aleixo Arruda / Universidade de Cuiabá; Raquel Maria Neves Amorim / Arruda, M.A. / Faculdade Ciências Médicas de Minas Amorim, R. M. N. / UNIC- Universidade de Cuiabá; Polyana Gerais; Barbara Andressa Soares Vieira / Vieira, B.A.S. / Silva Lemes / Lemes, P. S. / UNIC- Universidade de Cuiabá; Faculdade Ciências Médicas de Minas Gerais; Ana Paula Jessica Proença Derze / Derze, J. P. / UNIC- Universidade Drummond-lage / Drummond-Lage, A.P. / Faculdade de Cuiabá; Carla Joana Hugueney Franco Lobo / Lobo, C. Ciências Médicas de Minas Gerais. J. H. F. / UNIC- Universidade de Cuiabá; Rodolfo Edson de Franco Pimentel / Pimentel, R. E. F. / UNIC- Universidade Background: The use of opioids remains the primary de Cuiabá; Gilmar Ferreira Do Espírito Santo / Santo, G. F. therapy for cancer-related pain. However, ample E. / UNIC- Universidade de Cuiabá. evidence persists showing that this treatment is still inadequate. Objective: The purpose of this study was Introduction: The preoperative evaluation of the clinical to evaluate the impact of opioid use on analgesia and status of cancer patients aims to define the most important quality of life of patients with solid tumors. Methods: factors that increase the risks of a surgery and interfere A cross-sectional, analytical study was carried out with the postoperative development and the length of during one year in a Brazilian Public Cancer Center. hospitalization. Objective: To describe the risk factors Pain, depression, and quality of life were evaluated that increases the length of hospitalization on patients through validated instruments that included the Pain undergoing cancer surgery. Method: A retrospective Management Index, Quality-of-life questionnaire, Beck cross-sectional and descriptive study with 67 patients Depression Inventory, Douleur Neuropathique, Brief undergoing cancer surgery between July 2018 and February Pain Inventory-Short Form. Results: A hundred patients 2019 in a philanthropic hospital in Cuiabá - MT. The factors with advanced solid tumors were enrolled. 82% of them considered for the study were: age, gender, social habits, reported daily pain with 58% with severe pain. 57% subjective global assessment of nutritional status (SGA), were using morphine with a mean dose of 49 morphine physical status classified according to the American milligram equivalent. Pain management index was Society of Anestesiology (ASA), comorbidities, Goldman‘s negative in 34% of the patients. Neuropathic pain was cardiac risk score, nutritional risk evaluation (NRS-2002), found in 72%, and depression was severe in 90% of the nutritional intervention, pathways for a nutritional patients. Conclusions: No correlation between pain, recovery, length of hospitalization and patient evolution. depression, and quality of life was identified, despite the For the statistical analysis Epi Info version (7.2.3.1.) was substantial negative impact of pain on Quality-of-life. used. As an effect measure, relative risk (RR) was used, This gap can be explained due to the persistence of high 95% of a reliable interval (95% RI), with a significant level rates of undertreatment, depression and neuropathic of p <0, 05 Results: We evaluated 67 patients aged 52.9 pain associated with the use of low doses of opioids and ± 13.9 years old, 38 (56.72%) female, and 30 (44.78%) did adjuvant drugs. not have social habits. The average length of hospital stay was 24.83 ± 30.80 (1 to151 days). Regarding the functional Contato: Alberto Julius Alves Wainstein performance of patients, diabetes was the most prevalent [email protected] comorbidity (20.9%), 16 (23.88%) were malnourished (SGA B and C grouped), 52 (77.61%) had physiological disorder (ASA 2 to 4 grouped), 23 (34.33%) showed nutritional risk TEMÁRIO: OUTROS E MISCELÂNIA (NRS-2002 - score I to 3 grouped), 24 (40.30%) had class CÓDIGO: 87148 II cardiovascular complications, 31 (46.27%) required nutritional recovery and 52 (77.61%) evolved to discharge. TREINAMENTO EM VIDEOCIRURGIA The risk factors that were associated with longer length of hospital stay were malnutrition (RR = 3.9), physiological Autores: Ricardo Restivo de Castro Teixeira / RESTIVO, disorder (RR = 2.6) and cardiac risk (RR = 1.6). Conclusion: R.C.T. / Hospital Araújo Jorge; Diego Henrique Barros Our study main limitation can be related to the lack of da Silva / Barros, D.H.S. / Puc - Goiás; Arthur Fernandes information in our data base. However, our data suggests Fusco Pessoa / Pessoa, A.F.F. / Puc Goiás; Fátima Mrué that the risk of longer hospital stays is associated with the / Mrué, F. / Puc Goiás; Luciana Benevides de Araújo / functional performance of patients on the preoperative Benevides, L.B. / Puc - Goiás. stage. Therefore, preventive measures to correct surgical risk scores should be implemented to reduce the length of Introdução: A cirurgia videolaparoscópica foi o maior hospitalization of cancer patients. avanço da cirurgia no século XX, as inúmeras vantagens para o paciente fez com que a técnica se disseminasse Contato: Rafaela Cassia da Cunha Pedroso rapidamente. 1,3 Todavia, a curva de aprendizado [email protected] na cirurgia laparoscópica é maior do que na cirurgia convencional, 2 exigindo características mais específicas e complexas no processo de aprendizagem. Atualmente, TEMÁRIO: OUTROS E MISCELÂNIA o treinamento que é realizado pelos cirurgiões ocorre CÓDIGO: 88068 a partir de cursos, a maioria não vinculada instituições acadêmicas. E de caráter intensivo e esporádico, o THE IMPACT OF PAIN ON THE QUALITY OF que não contribui para o desenvolvimento de uma curva de aprendizagem satisfatória. 2,3 Os modelos LIFE OF CANCER PATIENTS ON OPIOIDS IN A de treinamento avançado utilizados geralmente são BRAZILIAN POPULATION modelos animais e simuladores de realidade virtual, Autores: Alberto Julius Alves Wainstein / Wainstein, de difícil acesso, dificultando assim o treinamento do A.J.A. / Faculdade Ciências Médicas de Minas Gerais; cirurgião. Objetivo: O presente estudo tem por objetivo fazer uma revisão sobre o treinamento de videocirurgia
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e seus modelos. Métodos: Este estudo constitui-se de ocasiões. No momento, a mesma se encontra em uma revisão sistemática da literatura especializada tratamento quimioterápico. Pouco é conhecido sobre o sobre modelos de aprendizagem e treinamento em comportamento biológico do TFS. Fatores de risco para videocirurgia na base de dados Pubmed, no Período de menor sobrevida livre de metástases incluem: margens 01 de Julho de 2013 a 01 de Julho de 2016, descritores: cirúrgicas comprometidas, tamanho maior que 10 cm laparoscopic AND training AND model, nos idiomas: e histologia maligna. Excisão completa é o tratamento Inglês, espanhol e português. Resultados: Foram recomendado. identificados 42 artigos, dos quais 15 foram excluídos por não preencherem os critérios de elegibilidade. Dos Contato: Renan Philippe Souza Pires 27 artigos restantes, 20 tinham como tema principal [email protected] programas de ensino e técnicas de treinamento em videocirurgia e 07 eram referentes a modelos de treinamento. A maioria dos artigos eram artigos originais, TEMÁRIO: OUTROS E MISCELÂNIA três eram ensaios clínicos, sendo dois randomizados CÓDIGO: 87445 e também um artigo de revisão de literatura e um retrospectivo. Quanto aos simuladores e modelos TUMOR PAPILÍFERO METASTÁTICO EM de treinamento, há um predomínio dos modelos do PAREDE ABDOMINAL COM SÍTIO PRIMÁRIO tipo caixa, úteis principalmente para treinamento de habilidades básicas. Quanto aos programas de DESCONHECIDO treinamento, a maioria descrevia programas de curta Autores: Mohamad Read Ali Tayeh / Tayeh, M. R. A. / duração e sem periodicidade indicada. Conclusão: Hospital e Maternidade Marieta Konder Bornhaunsen; Com base nos resultados deste trabalho, conclui-se Gabriela Aparecida Schiefler Gazzoni / Gazzoni, G. A. S. que há um consenso crescente sobre a necessidade / Universidade do Vale do Itajaí; Bethina Marafon Piva de treinamento formal em simuladores diversos, bem / Piva, B. M. / Universidade do Vale do Itajaí; Isabella como há um reconhecimento sobre a necessidade de de Oliveira / Oliveira, I. / Universidade do Vale do Itajaí; cursos específicos de videocirurgia para a formação do Vanessa Vizentin / Vizentin, V. / Universidade do Vale cirurgião. Quanto aos modelos de treinamento, os mais do Itajaí; Bárbara Wiese / Wiese, B. / Universidade utilizados são ainda os modelos de box, talvez pela sua do Vale do Itajaí; Thiago Henrique Piva / Piva, T. H. / simplicidade e facilidade de aquisição. Universidade do Sul de Santa Catarina.
Contato: Ricardo Restivo de Castro Teixeira Descrição do caso: C.A.F., feminina, 40 anos, relata [email protected] crescimento de massa em hipogastro, há 6 meses, associada a dor, inapetência e perda ponderal de 26 kg no período. Hábitos gastrointestinais e urinários TEMÁRIO: OUTROS E MISCELÂNIA preservados. Ressonância magnética (RM) abdominal CÓDIGO: 88025 evidenciou lesão expansiva em parede abdominal e pélvica de 15,8 x 18,1 x 13,4 cm, ovários com formações TUMOR FIBROSO SOLITÁRIO PÉLVICO: císticas foliculares e linfonodomegalia inguinal direita RELATO DE CASO de 3 cm. Os rins não apresentaram lesões expansivas. Paciente foi encaminhada para ambulatório de cirurgia Autores: Renan Philippe Souza Pires / Pires, R. P. S. / com suspeita de tumor ovariano. Biópsia revelou Hospital das Clínicas Doutor Mário Ribeiro; Ludimilla carcinoma de padrão papilar e sólido, sugestivo de Veloso Silva / Silva, L. V. / Faculdades Unidas do Norte carcinoma seroso. Foi iniciada quimioterapia (QT) com de Minas; Virginia Sousa Brito / Brito, V. S. / Hospital das carbo-taxol. A RM de controle mostrou um aumento Clínicas Doutor Mário Ribeiro; Guilherme Braz Pinto / de lesão expansiva, a qual se tornou indissociável Pinto, G. B. / Hospital das Clínicas Doutor Mário Ribeiro; ao ovário direito e redução do número, bem como Anne Júnea Barbosa Lopes / Lopes, A. J. B. / Faculdades do componente sólido dos linfonodos inguinais. Unidas do Norte de Minas; Claudiojanes Reis / Reis, C. / Ainda, houve aumento do Ca 125, de 372 para 2.955. Faculdades Unidas do Norte de Minas. Realizada ressecção de parede abdominal com reconstrução da mesma através de colocação de tela O Tumor Fibroso Solitário extrapleural (TFS) é uma e implante de pericárdio bovino para reconstrução de neoplasia mesenquimal rara, em que apenas 15-20% peritônio. Imuno-histoquímica evidenciou carcinoma apresentam comportamento maligno. Pode surgir de padrão túbulo-papilífero. A expressão para PAX8 em qualquer parte do corpo, sendo que a maioria levantou a possiblidade para rim e trato genital como é pleural e uma minoria extra pleural. O tumor extra sítios de origem mais prováveis, apesar dos rins não pleural acomete pacientes de todas as idades e sexo. apresentarem lesões expansivas. Nova avaliação do Ca Seu comportamento clínico costuma ser variável e 125 foi de 42. Optou-se, então, por iniciar QT adjuvante inespecífico, a depender do local acometido. O objetivo com carbo-taxol. Discussão: A carcinomatose deste estudo foi relatar um caso de tumor fibroso peritoneal é uma condição que pode estar presente na solitário pélvico, com os aspectos clínicos, radiológicos, história natural do câncer de ovário, do sistema genito- histológicos e imuno-histoquímicos característicos. urinário, colorretal, entre outros. A implementação da Nesse artigo, foi abordado o caso de uma paciente com cirurgia citorredutora radical seguida da quimioterapia manifestações clínicas de dor e aumento do volume hipertérmica intraperitoneal pré-operatória apresenta abdominal, com exame de imagem evidenciando aumento da sobrevida para diferentes tipos de massa de provável aspecto neoplásico, submetido à tumores associados ao comprometimento peritoneal. exérese da lesão como tratamento padrão em duas Pacientes em estágio IV que realizaram quimioterapia
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neoadjuvante à citorredução tiverem um menor risco follow-up the patient still hasn‘t shown signs of disease de óbito. O carcinoma papilífero representa cerca regression. Due to its rarity, there is no established de 15% dos carcinomas de células renais e divide- protocol for the clinical treatment of this disease. Some se histologicamente em tipo I e tipo II. No viés de studies have shown that propanolol can raise these tratamento, responde ao Sunitinibe, ao Bevacizumab patients overall survival rate. associado a Erlotinib e aos inibidores do proto- oncogene MET. Considerações finais: Com o presente Contato: Tariane Friedrich Foiato relato, enfatizamos a importância, apesar da baixa [email protected] prevalência, de tumores metastáticos com sítios primários indefinidos. TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS Contato: Mohamad Read Ali Tayeh CÓDIGO: 87499 [email protected] ABDOMINAL WALL TUMOR AFTER NEPHRECTOMY: A CASE REPORT TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS CÓDIGO: 87623 Autores: Haylla Haramoto / Haramoto, H. / Hospital Felício Rocho ; Guilherme Vaz de Melo Mota / Mota, A RARE BREAST CANCER Presentation: G.V.M / Hospital Felício Rocho; Diego Paim Carvalho ANGIOSARCOMA Garcia / Garcia, D. P. C. / Hospital Felício Rocho; Fernando Augusto de Vasconcellos Santos / Santos, F. Autores: Bruno Rafael Kunz Bereza / Bereza, B.R.K. / A. V. / Hospital Felício Rocho; Cyntia Ferreira dos Reis CEONC- Cascavel; Tariane Friedrich Foiato / Foiato, T.F. / Reis, C.F. / Hospital Felício Rocho; Leonardo Quinete / Ceonc- Cascavel; Tauana Karoline Friedrich Foiato / Guimarães / Guimarães, L.Q. / Hospital Felício Rocho; Foiato, T.K.F. / UniCesumar; Eduardo de Biasio Milano Felipe Romano Gonçalves Carvalho / Carvalho, F.R.G. / / Milano, E.B. / Centro Universitário Assis Gurgacz; Vitor Hospital Felício Rocho; Mariana Sala de Faria e Silva / Arce Cathcart Ferreira / Ferreira, V.A.C.F. / HU-UFGD; Silva, M.S.F / Hospital Felício Rocho; Thiago de Almeida Raimundo Romilton Leal Do Rosário / Rosário, R. L. R. Furtado / Furtado, T.A. / Hospital Felício Rocho; Cláudio / IOP; Ana Carolina Sayuri Tanamati / Tanamati, A. C. de Oliveira Chiaria Campolina / Campolina, C.O.C. / S. / Universidade Federal do Paraná; Lucas Tanamati Hospital Felício Rocho. Wisnieski / Wisnieski, L.T. / Universidade Federal do Paraná; Mateus Oliveira Damasceno / Damasceno, M.O. Case Presentation W.L.F, male, 43 years old, complaining / UniCesumar; Mônica Meneguette Silveira / Silveira, of bulging in left iliac region, 2 years after left M.M. / Centro Universitário Assis Gurgacz. nephrectomy for parental donation. On examination, an enlarged, hardened and adhered tumor of about 6 Breast cancer is the most common malignant neoplasia cm with inaccurate limits was observed. Tomography in women globally,disregarding non-melanoma skin showed expansive lesion in the distal segment of cancer. Angiosarcoma represents 0,002%-0,05% of all the oblique muscles of the left abdominal wall with primary breast tumors. Its highest incidence occurs in homogeneous enhancement by iodinated contrast, women 20-50 years of age. It is an aggressive tumor slightly irregular contours maintaining cleavage planes with a high recurrence rate and a short survival rate with adjacent rectus abdominis muscle, measuring varying from 1.1-2.8 years. It generally manifests itself 5.1x3.5x5.4 cm. The patient underwent tumor excision as a 04-05cm painful mass with a highly aggressive on the internal oblique muscle topography in the left pattern in imaging exams. The skin may present a iliac region, with reconstruction of the abdominal wall, reddish appearance without mamillary retraction. and anterior component separation was performed on Axillary involvement is rare, occurring in 0-5% of all the right, and intraperitoneal biosynthetic mesh (Bio-A) cases. There is great diagnostic difficulty due to high was placed, associated with polypropylene mesh. pre- rates of false negatives (37%) from core-needle biopsy. aponeurotic macroporous, without complications. The main treatment is surgical intervention, varying Pathological anatomy report revealed infiltrative lesion from radical mastectomy to lumpectomy. This case with spindle cells, with uncompromised margins, report is about a 31 y.o female patient who presented invading skeletal muscle and adipose tissue, suggestive with a non-painful mass at her right breast that grew of fibromatosis or desmoid tumor. At the moment in size during 04 months and underwent a core- awaiting immunohistochemical result. Discussion: needle biopsy.The mammography showed a 06cm Abdominal wall soft tissue tumors represent less mass at the right breast and staging exams showed than 10% of soft tissue tumors. The most common no sign of distant lesions. The biopsy results showed types are demoid tumors and soft tissue sarcomas, a high-grade neoplasia with skin and deep margins accounting for 45% and 40% of all abdominal wall involvement; the IHC confirmed a grade III (poorly tumors, respectively. Desmoid tumors are benign differentiated) angiosarcoma. The follow-up consisted myofibroblastic neoplasms originating from muscle in a radical mastectomy with the immediate placing of aponeurosis. Although they do not have metastatic a tissue expander. The final tumoral size of the surgical potential, they have an aggressive local invasion piece was 06x3.5cm. Weekly adjuvant chemotherapy potential, with infiltration and compression of adjacent (Taxol) for twelve weeks + 04 cycles of Ifosfamide and structures, with a high local recurrence rate. They are Adriamycin were prescribed followed by breast and highly prone to develop in surgical site scars, especially supraclavicular fossa radiotherapy. The patient is using post-caesarean scars and intra-abdominal resections. propanolol as a control treatment. After a 13-month Final comments: Management of the demoid tumor
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is typically performed by surgical resection. However, maintained aspiration of a large amount of pericatricial surgical resection of these tumors may be associated seroma until the 60th PO. The pathology revealed with high morbidity, depending on the neurovascular extra-skeletal myxoid chondrosarcoma (EMC), with structures located near the tumor and the size of positive immunohistochemistry for HDI1. The patient is the resection. In the case of lateral wall tumors, as in being followed with periodic consultations and remains the case presented here, resection of the tumor with without signs of local or distant recurrences. Discussion: subsequent closure without tension is often a challenge. EMF is a rare soft tissue tumor, usually located in the The use of surgical mesh in these cases is controversial. extremities, with a incidence between 50-60 years, with Given the location of the tumor and tissue loss, we unique cartilage-like histological features, marked by t opted for reinforcement of the wall with intraperitoneal (9; 22) (q22; q12.2) translocation. Despite slow growth, it absorbable mesh and macroporous pre-aponeurotic has high recurrence and local dissemination rates. The nonabsorbable mesh, with good results. most effective treatment is surgical removal, which has local recurrence rates of around 35% in 3 years. This Contato: Guilherme Vaz de Melo Mota patient had an unusual location for this type of tumor, [email protected] and although the reconstruction of the abdominal wall was not performed with double-sided mesh, which would be ideal, the use of polypropylene mesh associate TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS with omentoplasty to protect the intestinal loops was CÓDIGO: 87427 successful. Final comments: The case deals with a rare tumor (EMF), atypically located, infiltrating multiple ATYPICAL EXTRASKELETAL MYXOID CHON- intra-abdominal organs. In addition, reconstruction DROSARCOMA IN THORACOABDOMINAL of the abdominal wall using polypropylene mesh associated with omentoplasty was an alternative in the TRANSITION: CASE REPORT absence of double-sided mesh, with favorable results. Autores: Gustavo Braga de Faria / Faria, G. B. / UNIVERSIDADE FEDERAL DE UBERLÂNDIA; Camila Contato: Gustava Braga de Faria Leles Nascimento / Nascimento, C. L. / UNIVERSIDADE [email protected] FEDERAL DE UBERLÂNDIA; Tsbco Paulo Henrique de Sousa Fernandes / Fernandes, P. H. S. / UNIVERSIDADE FEDERAL DE UBERLÂNDIA; Tsbco Michel Jamil Chebel / TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS Chebel, M. J. / UNIVERSIDADE FEDERAL DE UBERLÂNDIA; CÓDIGO: 87674 Tsbco Marcelo Augusto Faria de Freitas / Freitas, M. A. F. / UNIVERSIDADE FEDERAL DE UBERLÂNDIA; José Avelino EPITHELIOID INFLAMMATORY MYOFIBRO- dos Santos Neto / Neto, J. A. S. / UNIVERSIDADE FEDERAL BLASTIC SARCOMA: A CASE REPORT DE UBERLÂNDIA; Kelly Martins Kawakami / Kawakami, K. M. / UNIVERSIDADE FEDERAL DE UBERLÂNDIA; Autores: Sérgio Murilo Pereira da Silva Filho / SILVA Margarida Cândido Guimarães Freire / Freire, M. FILHO, S. M. P. / Liga Acadêmica de Oncologia do C. G. / UNIVERSIDADE FEDERAL DE UBERLÂNDIA; Hospital de Base do Distrito Federal; Viviane Alves dos Paulo Henrique Gratão Rezende / Rezende, P. H. G. / Santos / SANTOS, V. A. / Liga Acadêmica de Oncologia UNIVERSIDADE FEDERAL DE UBERLÂNDIA; Mariana do Hospital de Base do Distrito Federal; Kétuny da Silva Akemi de Morais / Morais, M. A. / UNIVERSIDADE Oliveira / Oliveira, K.S. / Liga Acadêmica de Oncologia FEDERAL DE UBERLÂNDIA. do Hospital de Base do Distrito Federal; José Donato de Souza Netto / SOUSA NETTO, J. D. / Liga Acadêmica CASE: M.L.R., male, 62 years old, smoker (60 packs de Oncologia do Hospital de Base do Distrito Federal; year) has observed right thoracoabdominal wall Camille de Souza Carvalho / Carvalho, Camille. / Liga tumor, massive and hardened, since 2008 with Acadêmica de Oncologia do Hospital de Base do slow and progressive growth. Magnetic resonance Distrito Federal; Amarildo Henrique da Conceição imaging showed solid, intracavitary and expansive Junior / Conceição Junior, A. H. / Liga Acadêmica de formation (23x21x23 cm), with epicenter on the right Oncologia do Hospital de Base do Distrito Federal; thoracoabdominal wall and reaching the Morrison space, Mylena Valadares Silva / SILVA, M. V. / Liga Acadêmica characteristic of soft tissue neoplasia. Percutaneous de Oncologia do Hospital de Base do Distrito Federal; biopsy confirmed well-differentiated cartilaginous Bruno José de Queiroz Sarmento / SARMENTO, Bruno. malignant neoplasia. Chest and abdomen tomography / Liga Acadêmica de Oncologia do Hospital de Base do with no evidence of distance tumor. Definitive operative Distrito Federal; Helio Borges de Sousa / SOUSA, Helio treatment resulted in extensive resection of the right Borges. / Liga Acadêmica de Oncologia do Hospital de abdominal wall in conjunction with the right diaphragm Base do Distrito Federal. segment, 10th, 11th anda 12th right ribs and segment VI of liver. Due to the unavailability of the double-sided Case report: A 58 - year old man presented with mesh, we performed omentoplasty with rotation of weight loss, asthenia and increased abdominal volume. the greater omentum, suturing it to the abdominal Abdominal CT scan showed extensive abdominal wall defect in order to protect the abdominal content lesion, solid heterogeneous, with central necrosis and to avoid contact of the intestinal loops with the areas and calcification focuses, 2,0x16,5 cm, located in polypropylene mesh that was used for reconstruction the right flank/iliac fossa, involving mesenteric vessels of the abdominal wall sutured to the remaining and dislocating small bowel loops without intestinal abdominal muscles and the iliac crest. The patient was obstruction. 3 months ago went to surgery to elucidate discharged on the 2nd PO, using a suction drain that diagnosis, beyond realizing biopsy, the tumor was
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considered inoperable. The immunohistochemical abdominal volume for three months. He denied previous study (IHC) indicated a lesion with fibrosis, vascular pathologies. On physical examination, it was found a proliferation and presence of innumerable epithelioid globose abdomen with a large palpable and painless mass cells, broad cytoplasm, eosinophilic with big nucleus occupying the entire abdomen. The abdomen computed and prominent nucleolus (figure 1). Between the cells tomography revealed a 26 cm cystic abdominal lesion, there was inflammatory infiltration. IHC also revealed displacing adjacent structures, with renal parenchyma intense and diffuse CD30 expression (figure 2) and tapering, without visualization of urinary tract obstruction negative expression for ALK, suggesting Epithelioid to the method. The case discussed at a multidisciplinary Inflammatory Myofibroblastic Sarcoma. Patient is being meeting, with a diagnostic hypothesis of retroperitoneum treated with palliative chemotherapy protocol with cystic lesion causing mass effect, and surgical treatment Carbo + Taxol every 21 days for 6 cycles. Discussion The indicated. The inventory of the abdominal cavity revealed inflammatory myofibroblastic tumor (IMT) is rare and an extensive retroperitoneal lesion infiltrating the right occurs especially in the abdomen, pelvis and thorax. kidney, suprarenal, paravertebral muscles, ureter, and Approximately 50% of IMTs present abnormal anaplastic right gonadal vessels, adhered to the inferior vena cava, lymphoma kinase (ALK) due to rearrangements of the abdominal aorta, and vermiform appendix, displacing ALK gene. An intra-abdominal subclass of this tumor was liver, duodenum, and colon. Then performed an en bloc described, in 2011, termed by Epithelioid Inflammatory resection of the retroperitoneal tumor with nephrectomy, Myofibroblastic Sarcoma, an aggressive variant of the adrenalectomy, and resection of the right paravertebral tumor, constituted principally of epithelioid cells and musculature and appendectomy. Pathology reported proeminent neutrophilic infiltration. The EIMS has cystic lesion of fibrous walls partially covered by cuboidal predilection for intra abdominal regions; appearing cells, stratified, and chronic pyelonephritis, suggesting generally in male patients. The related cases denote giant hydronephrosis (GH), with no ureteropelvic wide morphological, immunohistochemical (CD30 obstruction and renal calculi. Immunohistochemistry expression) and clinical (anatomic location) related confirmed the cystic cavity lined with benign urothelium to EIMS. The solely absence of ALK expression would compatible with hydronephrosis. The patient discharged not correspond to EIMS. Nonetheless, it is important from the service. Discussion: The most common etiology to mention that a part of the cases do not express of GH is ureteropelvic junction stenosis, followed by ALK. Final Comments A rare Epithelioid Inflammatory lithiasis, trauma, and tumors of the urinary tract or Myofibroblastic Sarcoma case was described, ALK contiguous organs, which is rare in adults. The diagnosis negative and unresectable, still in investigation. Though of GH is challenging, sometimes presenting confounding the absence of ALK expression, the IHQ results suggest factors with malignant tumors, and in all retroperitoneal EIMS. Considering the case rarity, a NGS Foundation cystic mass should be considered the differential HEME was requested to confirm negativity of ALK diagnosis of GH, retroperitoneal tumor, retroperitoneal expression. If it is confirmed, the current treatment will hematoma, renal cysts, and ovarian tumors. As shown in continue. In case that positivity is confirmed, the patient this case, GH has a high potential to mimic malignancy, will start immunotherapy. due to clinical evolution, radiological findings, and even intraoperative inventory. Final considerations:GH is Contato: Sérgio Murilo Pereira da Silva Filho a rare condition to be considered in the presence of [email protected] abdominal cystic masses. Due to the vast number of differential diagnoses, the possibility of malignancy always should be considered, and the patient carefully TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS evaluated so that the correct early treatment instituted. CÓDIGO: 87959 Contato: André Luiz Costa e Silva GIANT HYDRONEPHROSIS MIMETIZING [email protected] RETROPERITONEAL TUMOR
Autores: André Luiz Costa e Silva / Silva, A. L. C. / Liga TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS Norte Riograndense Contra o Câncer; Thiago Costa Pires CÓDIGO: 87808 / Pires, T. C. / Liga Norte Riograndense Contra o Câncer; Luiz Cláudio Jammal Fernandes / Fernandes, L. C. J. / Liga GIANT INFERIOR CAVA VENA LEIOMYOSAR- Norte Riograndense Contra o Câncer; Bárbara Paulo COMA OBSTRUCTIVE ACUTE ABDOME DIF- Cavalcante / Cavalcante, B. P. / Liga Norte Riograndense Contra o Câncer; Amanda Barbetto Medeiros Torres ERENTIAL DIAGNOSIS IN EMERGENCY / Torres, A. B. M. / Liga Norte Riograndense Contra o Autores: Bruno Aquino Marcelino / Marcelino BA Câncer; Pedro de Albuquerque Mafaldo / Mafaldo, P. A. / Hospital Alberto Cavalcanti, FHEMIG; Ana Paula / Liga Norte Riograndense Contra o Câncer; Victor José Drummond-lage / Drummond-Lage AP / Faculdade Negreiros de Sá Rosado / Rosado, V. J. N. S. / Liga Norte Ciências Médicas de Minas Gerais; Luiza Ohasi / Ohasi Riograndense Contra o Câncer; Renata Beatriz Bessa L / Hospital Alberto Cavalcanti, FHEMIG; Rafael Barbosa Teixeira / Teixeira, R. B. B. / Liga Norte Riograndense de Santis / De Santis RB / Hospital Alberto Cavalcanti, Contra o Câncer; Marina Fernandes / Fernandes, M FHEMIG; Alberto Julius Alves Wainstein / Waisntein AJA / / Liga Norte Riograndense Contra o Câncer; Juliana Hospital Alberto Cavalcanti, FHEMIG. Maria Caetano Nogueira / Nogueira, J. M. C. / Liga Norte Riograndense Contra o Câncer. Case Report: A 77-year, female, sought medical care in an emergency room in a public hospital in the city Case Presentation: S.P.S., male, 44-years-old, admitted of Belo Horizonte, Brazil, with consumptive complaints with right flank pain and a significant increase in
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during the prior 3 months and a voluptuous abdominal B. / Liga Norte Riograndense Contra o Câncer; Pedro mass, associated with interruption in gas and feces de Albuquerque Mafaldo / Mafaldo, P. A. / Liga Norte elimination. She underwent abdominal computed Riograndense Contra o Câncer; Víctor José Negreiros de tomography that evidenced an expansive lesion with Sá Rosado / Rosado, V. J. N. S. / Liga Norte Riograndense central necrosis area in the right hypochondrium Contra o Câncer. and flank, that measured 19x15x13cm. Patient was diagnosed with low grade fusocellular neoplasia Case Presentation: G.F.C., female, 48-years-old, after core biopsy, and immunohistochemistry attends complaining of progressive weight loss (8 kg) identified leiomyosarcoma with moderated nuclear and abdominal mass growth for two years, associated pleomorphism. Considering this diagnostic hypothesis with abdominal pain, frequent vomiting, and weakness associated with intestinal obstruction, patient was in lower limbs, leading to falls. On physical examination, referred to oncological surgery for exploratory globose abdomen, distended, with mass occupying the laparotomy. During the surgery a lesion was found on entire abdomen. Abdominal computed tomography the inferior cava vena, below left renal vein, invading revealed a large pelvic-abdominal expansive lesion right renal vein and displacing colon without invading measuring 32.0 x 24.6 x 13.7 cm, affecting the adjacent structures. The following steps of the surgery uterus, with areas of necrosis inside, associated with were: dissection and repare of aorta artery and cava satellite neovascularization, adjacent small nodules, vein, up and downstream the lesion, followed by right and absence of lymph node enlargement. It was nephrectomy, ligation and resection of the inferior cava performed a laparotomy with enlarged hysterectomy vena below renal veins and on the emergence of the with bilateral adnexectomy, pelvic and retroperitoneal iliac veins. No vascular reconstruction was done, once lymphadenectomy, omentectomy, appendectomy, right patient had satisfactory collateral circulation. Patient colectomy with colostomy and multiple biopsies, the evolved with habitual postoperative, being discharged, surgery classified as R2. The giant tumor infiltrated the and is currently on ambulatorial follow up with no signs appendix, cecum, and jejunum, there were peritoneal of relapse. Discussion: The origin of inferior cava vena implants, and pelvic lymph node enlargement and leiomyosarcoma is on the smooth muscle tissue of the retroperitoneal. The pathology revealed spindle cell vessel. Symptoms vary according with the location, and epithelioid neoplasia infiltrating the bladder, cecal and the most important prognostic factors are the appendix, uterine body, and peritoneum, sparing the dimension of the tumor, the absence of palpable mass cervix, left annexes and right uterine tube. Currently, and pain. The Kulayalat Classification is used to describe awaiting immunohistochemistry. Discussion: tumoral topography on the inferior cava vena. The only Spindle cell and epithelioid neoplasms fit into soft treatment with healing potential is the radical surgical tissue tumors called sarcomas. Retroperitoneal resection with free margins and no metastasis, and sarcomas (RPS) constitute only 10-15% of soft tissue vascular reconstruction must be done when patients sarcomas, commonly diagnosed at more advanced lack satisfactory collateral circulation. Adjuvant and stages by late symptomatology caused by increased neoadjuvant treatment are controversial, but palliative tumor volume, neurovascular and gastrointestinal chemotherapy is being indicated in inoperable tumors compression. Surgical treatment is the only option with or metastasis. Final considerations:Inferior cava curative potential. Most experts define complete RPS vena leiomyosarcoma is rare, with reserved prognosis, resection as R0/R1, with ideally negative microscopic and early diagnosis is essential to increase survival margins (R0), although some suggest that long- among patients. Treatment must consist on oncologic term survival may be achieved with an R2 resection resection as the only healing alternative, associated with under certain circumstances with favorable subtypes. radiotherapy and chemotherapy as palliative options. Adjuvant therapy options still generate debate, and there is no consensus on the best approach. Final Contato: Bruno Aquino Marcelino considerations:Failure and delayed diagnosis of RPS [email protected] may result in progression with increased tumor volume and metastasis, and patients with suspicion must be referred to the referral service. TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS CÓDIGO: 88028 Contato: Víctor José Negreiros de Sá Rosado [email protected] GIANT RETROPERITONEAL SARCOMA: A CASE REPORT TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS Autores: Marina Ferandes / Fernandes, M. / Liga Norte CÓDIGO: 87967 Riograndense Contra o Câncer; George Alexandre Lira / Teixeira, R. B. B. / Liga Norte Riograndense Contra GIANT SOFT TISSUE SARCOMA: A CASE o Câncer; Thiago Costa Pires / Pires, T. C. / Liga Norte Riograndense Contra o Câncer; Gustavo Torres Lopes REPORT Santos / Santos, G. T. L. / Liga Norte Riograndense Contra Autores: Alice Dantas Leite / Leite, A. D / Universidade o Câncer; André Luiz Costa e Silva / Silva, A. L. C. / Liga Potiguar; Natalia Marcelino Araujo / Marcelino Araujo, N. Norte Riograndense Contra o Câncer; Barbara Paulo / Universidade Potiguar; Lucas Paschoal Silva / Silva, L. P Cavalcante / Cavalcante, B. P. / Liga Norte Riograndense / Universidade Potiguar; Tayla Cristina Lopes / Lopes, T. Contra o Câncer; Amanda Barbetto Medeiros Torres C / Universidade Potiguar; Larissa Medeiros da Fonseca / Torres, A. B. M. / Liga Norte Riograndense Contra o / Fonseca, L. M / Universidade Potiguar; Ana Beatriz Câncer; Renata Beatriz Bessa Teixeira / Teixeira, R. B. Varela Santos / Santos, A. B. V / Universidade Potiguar;
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Ana Camylla Vasconcelos Lapenda / Lapenda, A. C. V / N. Fernandes Loureiro / Lorena L. M. N. Fernandes Universidade Potiguar; Mycaele Carine dos Anjos Senra Loureiro / HOSPITAL OPHIR LOYOLA; Rodrigo / Senra, M. C. A. / Universidade Estadual do Rio Grande Custódio R. Aguiar / Rodrigo Custódio R. Aguiar / do Norte; Francimar Kétstia Serra de Araújo / Araújo, HOSPITAL OPHIR LOYOLA; Victor F. Ferreira / Victor F. K. S / Hospital Monsenhor Walfredo Gurgel; Leticia F. Ferreira / HOSPITAL OPHIR LOYOLA; Fabio A. Oliveira Sousa / Sousa, L. O / Universidade Potiguar. Morikawa Caldeira / Fabio A. Morikawa Caldeira / HOSPITAL OPHIR LOYOLA; Rafael Maia de Sousa / Case: Male, 48 years old, with progressive growth lesion in Rafael Maia de Sousa / HOSPITAL OPHIR LOYOLA; the adductor region of the left thigh, associated with local Luís C. Campelo Barbosa / Luís C. Campelo Barbosa / pain on exertion for 6 months. No risk factors or personal HOSPITAL OPHIR LOYOLA. cancer history, neoplastic family history (mother died of lung cancer). On examination: large mass occupying the Apresentação do caso: N.R.S., 54 anos, sexo entire medial and partial compartment of the posterior masculino, natural de Belém/Pará. Submetido region of the left thigh. Brought CT of the lower limbs à laparotomia exploradora em Março/2015, em presenting in MIE heterogeneous expansive lesion, with pronto socorro municipal devido quadro de abdome ill-defined limits, contrast-capturing with necrotic areas agudo obstrutivo, com achado intra-operatório de of permeability measuring about 16.7 x 10.2 x 11.0 cm (L tumoração estenosante em cólon direito, sendo x AP x T), estimated volume of 974.3 cm3, involving the realizada hemicolectomia direita com íleo-transverso adductor magnus muscle in the posteromedial face of anastomose. Foi cadastrado em Abril/2015, the left thigh, suspected for neoplasia in the left adductor apresentando estadiamento patológico pT3pN2pMx, muscle. Therefore, was decided to perform resection of estadio III, sendo então encaminhado ao tratamento this tumor with myocutaneous flap reconstruction. Thus, adjuvante, durante o qual realizou esquema FLOX no the entire medial compartment was excised + partial período de Junho a Outubro/2015. Em Dezembro/2018 resection of the vastus medialis muscle + myocutaneous iniciou queixa de dor em quadrante inferior direito flap reconstruction + left thigh inguinal lymphadenectomy. do abdome, ao exame físico foi possível observar The femoral and deep femoral vascular nerve bundles + e palpar tumoração de consistência endurecida sciatic nerve were in close contact with the tumor, having em topografia de crista ilíaca direita, tomografia been dissected in all its extensions. Discussion: Soft contrastada de abdome evidenciou tumoração com tissue sarcomas (STS) are rare malignant tumors that atividade osteoblástica em osso ilíaco à direita, estudo arise from extra-skeletal connective tissues, including de cintilografia óssea realizada em Fevereiro/2019 the peripheral nervous system. They are more common concluiu área de hipercaptação do traçador in extremities, especially lower limbs, and can occur superiormente em articulação sacro-ilíaca e crista anywhere. Its objective treatment: long-term survival, ilíaca à direita. Imuno-histoquímica de produto de avoid local recurrence, maximize function and minimize punção guiada do tumor confirmou adenocarcinoma morbidity. Surgical excision is potentially curative and metastático de origem colônica. Os demais exames diagnostic (through histopathology). In almost all patients de estadiamento radiológico não identificaram with tumors larger than 5 cm, the addition of radiotherapy doença em atividade em outros órgãos. O paciente optimizes local control and increases the chances of limb foi submetido à hemipelvectomia interna tipo I de preservation. Most STSs have a ≤5% risk of lymph node Enneking à direita, evoluindo satisfatoriamente no metastases, with the exception of synovial and vascular pós operatório, sem comprometimento da marcha, e sarcomas, rhabdomyosarcomas, epithelioid and clear cell recebeu alta hospitalar no sétimo pós operatório em subtypes (higher risk of nodal metastasis). In most cases, bom estado geral. No momento realiza seguimento regardless of the type of histological tumor, regional clínico-ambulatorial multidisciplinar com equipe lymph node dissection is recommended in case of clinical de oncologia cirúrgica, clínica, radioterapia e or radiological evidence of regional lymphadenomegaly. fisioterapia, permanecendo sem queixas Discussão: Final comments: This case is noteworthy and interesting O câncer colorretal (CCR) é o terceiro câncer em for the record, due to the large size of the tumor, which homens e o segundo em mulheres no mundo, sendo already caused functional damage to the patient, as well as mais frequente nos homens, é a quarta causa mais the relative complexity involved in the surgical procedure, comum de morte por câncer, a mortalidade é menor as well as the rarity of the STS. no grupo feminino. No Brasil, o CCR é a quarta causa de morte por câncer em homens e a terceira Contato: Natália Marcelino Araujo nas mulheres. As regiões sudeste e sul concentram [email protected] o maior número de casos. A metástase óssea é a neoplasia mais frequente do tecido ósseo, no caso do adenocarcinoma colorretal, o implante ósseo TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS representa 1% dos casos de metástase. Clinicamente, CÓDIGO: 86963 a dor é o principal sintoma ao diagnóstico Comentários finais: O implante metastático ósseo HEMIPELVECTOMIA INTERNA TIPO I DE EN- de adenocarcinoma colorretal é evento raro e NEKING NO TRATAMENTO DE ADENOCAR- constitui importante diagnóstico oncológico, seu diagnóstico precoce promove maiores chances de CINOMA METASTÁTICO COLORRETAL EM terapia curativa, além de promover melhor qualidade HOSPITAL DE REFERÊNCIA ONCOLÓGICA NA de vida ao paciente. AMAZÔNIA Contato: Rodrigo Luiz Ferreira Santos Autores: Rodrigo Luiz Ferreira Santos / RODRIGO L. [email protected] F. SANTOS / HOSPITAL OPHIR LOYOLA; Lorena L. M.
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TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS CÓDIGO: 87238 CÓDIGO: 88263
HEMIPELVECTOMIA INTERNA, UMA OPÇÃO HEPATIC FIBROSARCOMA: CASE REPORT DE PRESERVAÇÃO DE MEMBRO NOS Autores: Paulo Augusto Oliveira Carvalho de Goes / TUMORES DA CINTURA PÉLVICA Goes, P. A. O. C. / Complexo Hospitalar São Francisco de Assis; Priscilla Dias Silva / Silva, P. D. / Complexo Autores: Fabio Alves Morikawa Caldeira / Morikawa, Hospitalar São Francisco de Assis; Marcelo Vieira F. A. C. / Hospital Ophir Loyola; Victor Freitas Ferreira Gissoni de Carvalho / Carvalho, M. V. G. / Complexo / Ferreira, V. F. / Hospital Ophir Loyola; Rafael Maia de Hospitalar São Francisco de Assis; David Andrés Bravo Sousa / Sousa, R. M. / Hospital Ophir Loyola; Rodrigo Martinez / Martinez, D. A. B. / Complexo Hospitalar Custódio R. Aguiar / Aguiar, R. C. R. / Hospital Ophir São Francisco de Assis; Rodrigo Ralemadhá Gonçalves Loyola; Lorena L. M. N. Fernandes / Fernandes, L. L. M. Rodrigues / Rodrigues, R. R. G. / Hospital Vila da Serra; N. / Hospital Ophir Loyola; Rodrigo L. F. Santos / Santos. Danilo Esteves Pires Filho / Filho, D. E. P. / Complexo R, L. F. / Hospital Ophir Loyola; Saulo José Braga da Hospitalar São Francisco de Assis; José de Alencar Costa / Costa, S. J. B / Hospital Ophir Loyola. Gonçalves de Macedo / Macedo, J. A. G. / Hospital Santa Casa de Misericórdia de Belo Horizonte; Franco Antônio Apresentação do caso: Paciente D.M.G, 32 , sexo Cordeiro Neves / Neves, F. A. C. / Complexo Hospitalar masculino , foi encaminhado para avaliação com São Francisco de Assis; Diego Rolando Torrico Moscoso queixa de dor intensa em quadril e dificuldade / Moscoso, D. R. T. / Complexo Hospitalar São Francisco progressiva para deambulação há cerca de 6 de Assis. meses. Na tomografia computadorizada de pelve foi evidenciado uma formação expansiva Introduction: Primary liver sarcomas are rare. Among localizada no ilíaco anteriormente a direita com the types of sarcomas, fibrosarcoma is probably the áreas de destruição óssea. Paciente foi submetido most common. It is characterized by proliferation of a Hemipelvectomia Interna (HI) tipo I evoluiu sem malignant fibroblasts and myofibroblasts that are intercorrências durante a internação, com melhora arranged in fascicles and surrounded by a dense progressiva da dor , recebendo alta no 16º PO. collagen stroma. The prognosis is generally poor, with Biópsia da lesão concluiu que se tratava de um a survival of 3 to 12 months. Objective: To report the condrossarcoma. No acompanhamento ambulatorial case of a woman diagnosed with low to moderate paciente foi encaminhado para reabilitação com grade fusocellular hepatic neoplasia (fibrosarcoma). fisioterapia motora, com recuperação da função do Methodology: This is a qualitative, observational membro. Discussão: Os ossos da região pélvica são study of a case report regarding a patient seen at the sede de menos de 5% de todos os tumores ósseos General Surgery outpatient clinic of the São Francisco malignos. Apesar desta raridade, constituem capítulo de Assis Hospital Complex, located in Belo Horizonte - à parte no tratamento dos tumores ósseos, devido MG. Case Report: This is a 65-year-old female patient à complexidade anatômica da região. Permanecem, with a history of cervical cancer, with a progressive portanto, sendo um problema de difícil solução, ainda increase in abdominal volume, associated with severe nos dias de hoje. Atualmente as hemipelvectomias pain in epigastrium, dyspepsia and weight loss. são classificadas em externas e internas (preservação Magnetic Resonance Imaging described expansive do membro), a interna consiste na ressecção de right hypochondrium formation in a predominantly segmentos ósseos e tecidos comprometidos da subcapsular situation in close relationship with the costal cintura pélvica, preservando-se o feixe vásculo- surface of the entire liver, compressing and deflecting nervoso femoral e nervo ciático. Desta forma é inferior and left hepatic parenchyma, measuring 28.6 possível preservar o membro inferior dos pacientes x 22.5 x 13 cm. Patient underwent a Chevron incision com funcionalidade total ou parcial à longo prazo, laparotomy, identified as extracapsular large hepatic a HI é subdividida pela classificação de Enneking e tumor. The abdominal tumor was excised. The result of Dunham (ED) modificada em: Tipo I, ressecção da the anatomopathological study was mild intermediate asa do ilíaco; Tipo II, ressecção do acetábulo; Tipo III, fusocellular malignant neoplasia infiltrating the liver ressecção do ramo isquiopúbico; e Tipo IV, ressecção and surpassing the capsule. It was recommended to da articulação sacroilíaca; sendo ainda acrescentado complement with immunohistochemistry for definitive o sufixo H, caso ocorra a ressecção da cabeça do classification of the tumor. The immunoexpression fêmur. Comentários finais: Com o desenvolvimento profile associated with morphological aspects favored de novas drogas quimioterápicas, radioterapia, a diagnosis of fibrosarcoma. The patient evolved métodos diagnósticos e novas técnicas cirúrgicas, uneventfully. Discussion: Fibrosarcoma is a tumor houve aumento do número de pacientes que foram composed of highly malignant fiber-forming connective submetidos a cirurgias de preservação dos membros tissue cells that usually affects the legs, arms, or trunk. (HI). Desde que seja possível margem oncológica Prognosis is determined according to the degree of de ressecção, as cirurgias preservadoras devem ser tumor malignancy and the stage at which it is found at buscadas, no sentido de obter menor morbidade e the time of diagnosis. Diagnosis is usually late, when prejuízo na qualidade de vida dos pacientes uma vez the tumor mass in the abdomen is palpable, physical que estes costumam ser jovens em sua maioria. examination and abdominal ultrasound studies are diagnostic. Complete resection of the tumor is the Contato: Fabio Alves Morikawa Caldeira most important for healing. Conclusion: It is concluded [email protected]
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that hepatic fibrosarcomas are rare, have malignant TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS behavior and should be included in the differential CÓDIGO: 88277 diagnosis of patients with abdominal masses. INTERNAL HEMIPELVECTOMY FOR TREAT- Contato: Paulo Augusto Oliveira Carvalho de Goes MENT OF EXTENSIVE GIANT CELL TUMO: [email protected] CASE REPORT Autores: Yzabella Gomes Fernandes Santana / Santana, TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS Y. G. F. / Universidade Federal de Uberlândia; Paulo CÓDIGO: 87874 Henrique de Sousa Fernandes / Fernandes, P. H. S. / Universidade Federal de Uberlândia; Michel Jamil Chebel HIGH-GRADE ABDOMINAL WALL EXTRASKEL- / Chebel, M. J. / Universidade Federal de Uberlândia; ETAL OSTEOSARCOMA: A CASE REPORT Marcelo Augusto Faria de Freitas / Freitas, M. A. F. / Universidade Federal de Uberlândia; Marcela Almeida Autores: Anna Paula de Sousa Silva / Silva, A. P. S. Mendonça / Mendonça, M. A. / Universidade Federal / LAONCO - IHBDF; Thaynara de Carvalho Ribeiro de Uberlândia; Luana Renata Viegas Jorge / Jorge, L. R. / Ribeiro, T. C. / Liga Acadêmica de Oncologia do V. / Universidade Federal de Uberlândia; Camila Leles Hospital de Base do Distrito Federal; Sérgio Murilo Nascimento / Nascimento, C. L. / Universidade Federal Pereira da Silva Filho / Silva Filho, S. M. P. / Liga de Uberlândia; Ana Júlia Marquez Pajuaba / Pajuaba, Acadêmica de Oncologia do Hospital de Base do A. J. M. / Universidade Federal de Uberlândia; Carla Distrito Federal; Kétuny da Silva Oliveira / Oliveira, K. Aparecida Pinheiro / Pinheiro, C. A. / Universidade S / Liga Acadêmica de Oncologia do Hospital de Base Federal de Uberlândia; Roberto Reggiani / Reggiani, R. do Distrito Federal; Viviane Alves dos Santos / Santos, / Universidade Federal de Uberlândia. V. A. / Liga Acadêmica de Oncologia do Hospital de Base do Distrito Federal; Henrique Barbosa de Abreu / R.C.R, 18 years old, female, sought medical attention Abreu, H. B. / Liga Acadêmica de Oncologia do Hospital complaining of left lower limb pain associated with de Base do Distrito Federal; Beatriz Pires Paes / Paes, progressive growth tumor in the left hip during 8 B. P. / Liga Acadêmica de Oncologia do Hospital de months. Computed tomography was performed, which Base do Distrito Federal; Bruno José de Queiroz showed a tumor in the left iliac bone of approximately Sarmento / Sarmento, B. J. Q. / Unidade de Cirurgia 20 centimeters, with involvement of the abdominal Oncológica do Instituto Hospital de Base; Rodrigo muscles. Investigation was performed with iliac bone Nascimento Pinheiro / Pinheiro, R. N. / Unidade de curettage whose anatomopathological report revealed Cirurgia Oncológica do Instituto Hospital de Base; Giant Cell Bone Tumor. Neoadjuvant treatment with Cintia Barboza Batista / Batista, C. B / Unidade de Denosumab was indicated for 4 weeks and left internal Cirurgia Oncológica do Instituto Hospital de Base. hemipelvectomy (Type I) was performed, with resection of the iliac bone and most of the ipsilateral abdominal A 40-year-old female who 18 years ago had abdominal wall, preserving the femoral and sciatic nerves, as liposarcoma treated with surgery and radiotherapy. well as the left lower limb. The patient continued with Since 2016, exams revealed reccurrence with gradual adjuvant treatment with Denosumab and clinical follow- growth of mass located in the right hypochondrium, up. In the eighteenth month after surgery, a follow-up in cholecystectomy scar. The abdominal mass was computed tomography was performed, which showed already measured at 8.4 x 7.0 x 9.2 cm. At January 2018, expansive lesions in the left hip, in close contact with a new surgery was performed. The procedure involved colonic loops in the rectosigmoid transition associated resection and reconstruction of the abdominal wall with lymph node enlargement. Exploratory laparotomy with mesh and rectus abdominis myocutaneous was indicated whose inventory found neoplastic flap (TRAM). Complications weren´t reported during implants in rectosigmoid transition, right ovary, uterus postoperative period. A diagnosis of high-grade and left retroperitoneal region. Rectosigmoidectomy, abdominal wall extraskeletal osteosarcoma was hysterectomy, bilateral salpingoophorectomy made based on immunohistochemistry of excised and lymphadenectomy were performed. The material. At January 2019, adjuvant radiotherapy anatomopathological report showed the presence was completed while chemotherapy continues until of a tumor compatible with Giant Cell Tumor in all October 2019. Sarcomas are rare tumors characterized the analyzed pieces, but, despite infiltrating the by involvement of mesenchymal tissues. There are evaluated organs, there was no finding of sarcomatous subtypes of sarcomas. In extraskeletal osteosarcoma, component. Giant cell bone tumor represents about biopsy reveal a presence of osteoid cells without a 10% of primary bone tumors. It is usually a lesion with coexistence of a primary bone tumor. This rare type of benign behavior, mainly affecting the epiphysis of the neoplasm accounts for about 4% of all osteosarcomas. long bones, occurring preferentially in the distal femur This case report shows that high-grade abdominal and proximal tibia, and may also affect the pelvis and wall extraskeletal osteosarcoma can be reccurrence sacrum. It usually occurs in young adults and their of previous neoplasm or condition radiotherapy- behavior may be indolent or locally aggressive. Rarely induced. Therefore, it´s seeking the understanding metastases may occur from histologically benign of the aspects associated to the appearance of the lesions. In the case described, despite aggressive neoplasm and the good response with the treatment. local surgical treatment (hemipelvectomy) associated with target therapy (Denosumab), the patient evolved Contato: Viviane Alves dos Santos with recurrence and invasion of abdominal organs. [email protected] The reported evolution, even without evidence of
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malignancy, demonstrates an atypical behavior of this The choice of a surgical technique for the local control benign tumor, which may be due to the large size and of the disease that allows the preservation of the lower advanced stage of the disease at diagnosis. limb associated to an R0 resection has an important impact on the survival, rehabilitation and quality of life Contato: Yzabella Gomes Fernandes Santana of the patient. [email protected] Contato: Renan Danilo Lima da Rocha [email protected] TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS CÓDIGO: 87382 TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS INTERNAL HEMIPELVECTOMY: CASE REPORT CÓDIGO: 87822 Autores: Renan Danilo Lima da Rocha / ROCHA, RDL INVASION OF EXTERNAL ILIAC VEIN BY / Hospital Adventista de Manaus; Marco Antonio Ricci Correa Junior / CORREA JUNIOR, Marco Antonio Ricci / PELVIC LEIOMYOSARCOMA - CASE REPORT Hospital Adventista de Manaus; Manoel Jesus Pinheiro Autores: Bruna da Silva Feitosa / Feitosa, B. S. / Liga Coelho Junior / COELHO JUNIOR, M. J. P. / Hospital Acadêmica de Oncologia do Hospital de Base do Adventista de Manaus; Ricardo Monteiro da Silva / Distrito Federal; Viviane Alves dos Santos / Santos, V. SILVA, R. M. / Hospital Adventista de Manaus; Wagner A. / Liga Acadêmica de Oncologia do Hospital de Base de Oliveira Junior / OLIVEIRA JUNIOR, W. / Hospital do Distrito Federal; Mariana Silva Santana / Santana, M. Adventista de Manaus; Alexandre Balbino da Costa / S. / Liga Acadêmica de Oncologia do Hospital de Base COSTA, A.L. da / Hospital Adventista de Manaus; Pedro do Distrito Federal; Amarildo Henrique da Conceição Machado Martins Neto / MARTINS NETO, P. M. / Hospital Junior / Junior, A. H. da C. / Liga Acadêmica de Oncologia Adventista de Manaus; Juliana Alves Prado / PRADO, J.L. do Hospital de Base do Distrito Federal; Thalita Millene / Hospital Adventista de Manaus. Moura / Moura, T. M. / Liga Acadêmica de Oncologia do Hospital de Base do Distrito Federal; Clara Costa Case Presentation: A 20-year-old male patient, Mendes / Mendes, C. C. / Liga Acadêmica de Oncologia previously healthy, initiated a symptom of hip pain at do Hospital de Base do Distrito Federal; Beatriz Carneiro rest with significant worsening at night. He denied a Habbema de Maia / De Maia, B. C. H. / Liga Acadêmica history of trauma as well as other associated symptoms. de Oncologia do Hospital de Base do Distrito Federal; He had no family history of chronic diseases and Bruno José de Queiroz Sarmento / Sarmento, B. J. de Q. neoplasms. In an outpatient follow-up, he presented on / Unidade de Cirurgia Oncológica do Instituto Hospital the Magnetic Resonance Imaging (MRI) of the left hip a de Base; Rodrigo Nascimento Pinheiro / Pinheiro, R. N. lesion with poorly defined limits, with hypersignal at T2- / Unidade de Cirurgia Oncológica do Instituto Hospital weighted sequence and heterogeneous enhancement de Base; Bruno Santos Wance de Souza / De Souza, B. S. to the contrast, suggestives of neoplastic process. W. / Unidade de Oncologia Clínica do Instituto Hospital This lesion doubled in the radiological control after de Base. 60 days. In view of such radiological progression, the patient underwent surgical resection of the lesion R.J.S., female, 42 years old, 2 years ago reported edema, through Internal Hemipelvectomy Type I and Type movement pain, hyperemia and hypoesthesia, all in the II (surgical classification of Enneking) on the left. right lower limb (RLL). On physical examination of the Anatomopathological revealed a poorly delimited, RLL, hyperemia, 3 + / 4 + edema, restricted movement, brownish and elastic nodular lesion measuring 5.0 x 4.0 calf bulging, and popliteal wrist with asymmetry. x 2.6 cm with negative surgical margins corresponding Contrast-enhanced CT and abdominal MRI revealed an to the small differentiated malignant neoplasm of small expansive 40x25mm lesion, anteromedially to the right cells (small round cell and blue tumor) compatible with external iliac vein (REIV), with signs of tumor thrombosis. the diagnosis of Bone Ewings sarcoma. Discussion: An exploratory laparotomy was performed with total Ewings sarcoma is a cancer of unknown cause, without resection of the retroperitoneal tumor and the REIV risk factors, not hereditary, with peak incidence around and freezing biopsy, showing a malignant tumor, with 15 years, having the pelvis as its primary main site. Lung no defined primary site. Compatible with high grade and bones are reported as major metastatic sites. Overall epithelioid pelvic spindle cell leiomyosarcoma (LMS) five-year survival for patients with localized disease is and G3 staging, pT1b Nx M0, adjuvant chemotherapy around 70-80%, however, it is lower in those with pelvic (CHEMO) was initiated. Eleven months ago, edema, tumors. Less than 25% of patients present distant low back pain, difficulty in walking and abdominal metastases at diagnosis. Survival reduces to around pain resumed. New MRI showed tumor recurrence, 30% when metastases are present at diagnosis. The with pelvic masses, vessel invasion, and spinal cord internal hemipelvectomy has as a technical principle the compression. At the moment, she is in CHEMO and preservation of the femoral vessels, femoral nerve and pain treatment. LMS can appear in any anatomical sciatic nerve, not requiring amputation of the ipsilateral site, including the pelvis. In it, tumoral lesions are rare, lower limb. The complete resection of the lesion, with and bone sarcomas, followed by soft tissue sarcomas, negative surgical margins, appears as an important are the most common. Its clinical is nonspecific, prognostic factor in the survival of patients with pelvic originated from the displacement of structures. The tumors. Final comments: In the patient in question, LMS is suspected by imaging exams (CT and MRI) and the type of surgical approach used allowed complete confirmed by biopsy, being distinguished in three resection of the lesion, with negative surgical margins degrees, based on differentiation, necrosis, and mitotic without the need for amputation of the ipsilateral limb.
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rate. In this case, a rapidly growing undifferentiated G3- de dor, seguindo para ressecção do tumor. Com onze compatible epithelioid pelvic spindle cell MMS, pT1b Nx dias de pós-operatório foi feito a reconstrução com M0, has been described. Local recurrences are related confecção de retalho miocutâneo e após um mês to the location, size, and histology of the LMS. In the realizou enxerto dermo-epidermico. Discussão: os pelvis, recurrence is frequent due to difficult access. leiomiossarcomas em extremidades compreende cerca LMS is an uncommon soft tissue tumor, accounting for de 10% a 15% dos sarcomas e tendem a alcançar um about 7%. Its mass growth usually causes nonspecific melhor prognóstico do que o uterino, retroperitoneal symptoms, but, as in the case described, it can lead e de vasos maiores. A quimioterapia não se mostrou to an exuberant clinical picture due to the invasion of muito eficaz na redução do tumor, mas a ressecção foi important structures. Surgical resection of the tumor is o principal tratamento local para a paciente influindo the main treatment and a good prognostic factor since, na sua sobrevida. Segue em acompanhamento when total, it leads to a 60% survival, compared to 35% ambulatorial. Comentários finais: o leiomiossarcoma when it is partial. Adjuvant CHEMO and radiotherapy ocorre predominantemente no retroperitôneo ou are used in high-grade tumors, and biopsy is of utmost intra-abdominal e é menos comum nas extremidades. importance. Thus, although the local recurrence rate Surge predominantemente em vasos sanguíneos, com is 50%, an early and aggressive recurrence is possible, uma preferência pelo membro inferior, podendo afetar as in the case reported here, leading to a difficult to estruturas vasculares próximas. control cancer condition, with salient symptomology, and a worse prognosis. Contato: Jacira Patricia Rocha Monteiro [email protected] Contato: Viviane Alves dos Santos [email protected] TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS CÓDIGO: 85166 TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS CÓDIGO: 88339 LIPOSSARCOMA MIXÓIDE DE MEMBRO SUPERIOR RECIDIVADO RELATO DE CASO LEIOMIOSSARCOMA DE PARTES MOLES EM EXTREMIDADE SUPERIOR RELATO DE CASO Autores: Tais Menezes Magalhães / Magalhães, T. M. / Hospital Amaral Carvalho ; Junea Caris de Oliveira / Autores: Jacira Patricia Rocha Monteiro / MONTEIRO, Oliveira, J. C. / Hospital Amaral Carvalho; Daiana Lopes J. P. R. / UFAL; Caroline Carvalho Ferro / FERRO, C. C. / Do Nascimento / Nascimento, D. L. / Hospital Amaral HU- UFAL; Elizabete Gonçalves dos Santos / SANTOS, E. Carvalho; Ana Thereza Bissoli / Bissoli, A. T. / Hospital G. / HU-UFAL; Júlia Teresa de Albuquerque Celestino / Amaral Carvalho; Flávia Ferreira Magalini / Magalini, CELESTINO, J. T. A. / HU-UFAL; Cássia Priscilla Tenório F. F. / Hospital Amaral Carvalho; Eduardo Marcucci Do Nascimento / NASCIMENTO, C. P. T. / HU-UFAL; Pracucho / Pracucho, E. M. / Hospital Amaral Carvalho; Adriana Melo Barbosa Costa / COSTA, A. M. B. / HU- Renato Morato Zanatto / Zanatto, R. M. / Hospital UFAL; Tadeu Gusmão Murutiba / MURITIBA, T. G. / HU- Amaral Carvalho. UFAL; José Cardoso Cavalcante Júnior / JÚNIOR, J. C. C. / HU-UFAL; Daniel Florêncio Ferro / FERRO, D. F. / HU- O lipossarcoma é o sarcoma de partes moles mais UFAL; Viviane Honório Mendonça da Costa / COSTA, V. frequente, com pico de incidência entre os 40 e H. M. / HU-UFAL. 60 anos e mais comum em homens. Metastatiza habitualmente para o pulmão, com exceção do sub- Introdução: O leiomiossarcoma de tecido mole tipo mixóide, onde a metastatização é sobretudo é uma neoplasia mesenquimal maligna rara que no esqueleto axial. Os lipossarcomas podem ser surge da musculatura lisa. Caso: C.L.S, 61 anos, divididos em três subtipos histológicos: 1-lipossarcoma sexo feminino, relata que há aproximadamente 1 bem diferenciados; 2-lipossarcoma mixóide/células ano iniciou quadro de dor e câimbras associado ao redondas; e 3-pleomórfico. O tipo mixóide corresponde crescimento de uma tumoração no antebraço direito, a 50% de todos os lipossarcomas, com prognóstico de com crescimento progressivo desde então. Procurou cinco anos de sobrevida maior que 88%. Dificilmente serviço médico que realizou biopsia sendo compatível apresenta metástases, podendo ocorrer para pulmões com leiomiossarcoma moderadamente diferenciada, e fígado, sendo que a disseminação para linfonodos apresentando 5% necrose focal, margem óssea livre é rara e sugere doença avançada. RELATO DE CASO: de infiltração. Foi encaminhada ao serviço de oncologia Paciente do sexo masculino, 49 anos, HIV positivo do hospital onde foi solicitado uma ressonância de em uso de TARV com carga viral indetectável, deu braço direito com contraste que mostrava volumosa entrada em hospital público oncológico em 13 de lesão expansiva heterogênea, sólido-cística, medindo janeiro de 2016 apresentando tumoração de 4x4cm cerca de 14x12x10cm, com captação heterogênea pelo em face anterior de antebraço esquerdo, dolorosa, meio de contraste, localizada nas partes moles da face com crescimento há 1 ano, sobre cicatriz cirúrgica. anterolateral do terço proximal e médio com sinais Paciente com passado de quatro ressecções cirúrgicas de invasão da musculatura adjacente e discretamente prévias em mesma topografia na cidade de origem, do terço médio do rádio, com deslocamento do feixe a primeira no ano de 2000, com anatomopatológico vasculho-nervoso, mas sem sinais nítidos de invasão de 2014 (última cirurgia) de lipossarcoma mixóide. do mesmo, sugestivo de neoplasia sarcoma de partes Após quarta recidiva foi submetido a 28 sessões de molese. Submetida a 4 ciclos de quimioterapia, sem radioterapia. Realizada em 13 de dezembro de 2018 redução importante da tumoração, apenas do quadro ressecção marginal do tumor com margens amplas
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e reconstrução com retalho dermocutâneo inguinal performed using the Cox regression model. Results: Of (groin flap). Histopatológico de lipossarcoma mixóide the 92 patients in the study, 41 (44.6%) had NF1 and margens livres. Não indicada quimioterapia e liberação compared with the non-NF1 group 51 (55.4%) showed do retalho feita em 17 de janeiro de 2019 com boa some differences: in the mean age, 36.2 years in the evolução. O lipossarcoma mixóide representa 30-35% NF1 group and 49 years in the group without NF1 (p dos lipossarcomas e é definido como uma variante = 0.001). There was a predominance of males in the de lipossarcoma com lipoblastos que frequentemente NF1 group (1.3 / 1) (p = 0.46). Tumors larger than 10 cm são do tipo anel de sinete, com padrão capilar predominated in the NF1 group (p = 0.003). There was plexiforme, matriz mixóide com mucopolissacarides no significant difference between the groups regarding sensíveis à hialuronidase. O lipossarcoma mixóide é the distribution by color or race, the first symptom, particularmente sensível à radiação e quimioterapia the disease evolution time until diagnosis and staging. quando comparado a outros subtipos histológicos de Univariate analysis adversely affected overall survival: sarcoma de partes moles, resultando em sobrevida em tumor size greater than 10 cm (p = 0.0056), presence of 10 anos de até 87%. A variedade de células redondas é NF1 (p = 0.0001) and palliative treatment (p = 0.0001). considerada uma forma mal diferenciada da mixóide, None of the variables were significant in calculating com desenvolvimento de metástases em até 21% disease-free survival. In the multivariate analysis, the dos pacientes. A excisão radical continua sendo o presence of NF1 (p = 0.0084) and curative treatment (p tratamento de escolha do lipossarcoma. A radioterapia = 0.00001) were statistically significant. Survival at 2 and pós operatória é um adjuvante ao procedimento 5 years in the NF1 TMBNP group was 21% and 18% and cirúrgico, indicado principalmente em lesões maiores in the non-NF1 group was 76% and 40%. Conclusion: de 5cm. Linfadenectomia profilática não é indicada em Patients with TMBNP and NF1 have larger tumors, virtude de esses tumores raramente apresentarem disseminated at the time of diagnosis, and have a worse metástase linfática. prognosis compared to patients without NF1 in the population studied. Contato: Tais Menezes Magalhães [email protected] Contato: Vinícius Pessoa Galvão [email protected]
TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS CÓDIGO: 88241 TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS CÓDIGO: 87286 MALIGNANT PERIPHERAL NERVE SHEAT TUMOR: 20 YEARS OF EXPERIENCE OF AN MALIGNANT TUMOR OF PERIPHERAL NERVE ONCOLOGICAL CENTER SHEATH Autores: Roberto André Torres de Vasconcelos / Autores: Adriano Eduardo Costa de Figueiredo / Vasconcelos, R. A. T. / INCA; Fernanda Alonso Rodriguez FIGUEIREDO, A.E.C. / Instituto Nacional de Câncer Fleming / Fleming, F. A. R. / INCA; Vinícius Pessoa Galvão (INCA); , Felipe Lins Trigueiro Mendes / MENDES, F.L.T. / Galvão, V. P. / INCA; Ketheryn Adna Souza de Almeida / Instituto Nacional de Câncer (INCA); Bruna Roberta / Almeida, K. A. S. / INCA; Nelson José Jabour Fiod / Fiod, Lima Baia de Figueiredo / FIGUEIREDO, B.R.L.B. / N. J. J. / INCA; Marcus André Acioly de Sousa / Sousa, M. Universidade Federal do Pará (UFPA); Andréia Salarini A. A. / Hospital do Andaraí. Monteiro / MONTEIRO, A.S. / Instituto Nacional de Câncer (INCA); Márcia Nogueira Carreira / CARREIRA, Introduction: Malignant peripheral nerve sheath tumor M.N. / Instituto Nacional de Câncer (INCA); Gustavo (TMBNP) is a malignant neoplasia of mesenchymal Santiago Melhim Gattás / GATTÁS, G.S.M. / Instituto origin that occurs in the peripheral nerve or has aspects Nacional de Câncer (INCA); Gustavo Soares de Moura of neural lineage differentiation with aggressive Pierro / PIERRO, G.S.M. / Instituto Nacional de Câncer characteristics and early evolution to metastases. In up (INCA); Emanuel Bastos Torquato / TORQUATO, E.B. / to half of cases, TMBNP appears in people with type 1 Instituto Nacional de Câncer (INCA); Aureliano Mota neurofibromatosis (NF1). When associated with NF1, Cavalcanti de Sousa / SOUSA, A.M.C. / Instituto Nacional TMBNP seems to evolve faster, with a worse prognosis, de Câncer (INCA); Samuel Zuinglio de Biasi Cordeiro / but it is still controversial whether this is attributed to CORDEIRO, S.Z.B. / Instituto Nacional de Câncer (INCA). greater biological aggressiveness or diagnostic delays, which would allow the progression of the neoplasm Case Report: A.Q.O., male, 38 years old, with a history leading to decreased survival. Objective: To evaluate of cervical tumor operated on in 2006 and diagnosed clinical differences between patients with TMBNP and with schwannoma. He was referred to the Collegiate NF1 and those without NF1 and to analyze whether of the Thorax in 2012 due to 6cm left hemithorax they have an influence on survival.Methods: Data were mass seen on tomography. It had coffee stains with studied from the medical records of patients enrolled milk and neurofibroma. Deliberate surgery, but the in an oncology center diagnosed with TMBNP from patient abandoned the treatment. He returned to the Jan/1990 to Dec/2010. Differences between groups institution in 2018 with chest pain, dyspnea, 30 kg loss were assessed by Student‘s t-test, Mann-Whitney and and dysphonia. New exams (PHOTOS 1 and 2) showed Pearson‘s t-tests. Global and disease-free survival the presence of a lesion occupying the entire left was calculated by the Kaplan-Meier method and the hemithorax (20x17.6x14.6cm). The patient underwent difference between the variables evaluated by the log tumor resection with left pneumonectomy due to lung Rank test. A multivariate analysis of overall survival was tumor involvement (09/20/2018). Freezing compatible
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with peripheral nerve sheath malignant tumor better disease control. Objective: To report a case of (MTPNS). In the immediate postoperative period, the Merkel cell carcinoma treated in a tertiary hospital in patient developed a clot syndrome requiring further Porto Alegre. Methods: Analysis of medical records surgery (PHOTO 3). He was discharged from hospital in and data collection, preceded by detailed anamnesis good condition. Final result of the piece showed 30cm and physical examination, with subsequent literature TMBNP with lung infiltration, S100 protein positivity and review. Case Report: A 59-year-old male postman, free limits (pT2N0M0). Requested opinion from Clinical smoker, with a previous diagnosis of basal cell Oncology and Radiotherapy. Adriamycin treatment carcinoma and the removal of neoplastic lesions on was started but discontinued due to the appearance the face and chest 5 years ago, returns to the hospital of a new chest wall tumor whose biopsy was also reporting a prominent nodule in the left axillary region, compatible with MTPNS (PHOTO 4). Changed scheme 60 days earlier. Declares to work with face and upper for ifosfamide. At the end of radiotherapy sessions. limbs exposed to sunlight without photoprotection. Discussion: The MTPNS is characterized by being a On physical examination, fixed adenopathy, hardened, rare type of sarcoma, aggressive and associated with without stone aspect, with a diameter of 4cm. Laboratory neurofibromatosis. It has a frequency of 0.001% in the tests without major changes. Two weeks later, the population and predominance between 20-50 years. patient underwent left axillary lymphadenectomy, It manifests as a rapidly growing mass, significant the result of which was immunohistochemical and pain symptoms, sensorineural deficits and a high pathological study compatible with metastasis of relapse rate (40-65%). The patient had some conditions neuroendocrine carcinoma. The expression of the associated with the pathology, such as age, presence protein CK20 corroborated the diagnosis of Merkels of neurofibromatosis and local symptoms. Patients tumor. Complementary staging, after computed generally have a five-year survival rate of 34-64%. tomography of the head, neck, chest, abdomen and Factors of poor prognosis are: tumor location, lesion musculoskeletal system, was negative for neoplastic size and free margins. Because they are chemo and lesions in these regions, indicating a hidden primary radioresistant, surgery prevails in most cases. Final site. The patient is being followed up for future additive comments: Exposing this case to the scientific literature axillary lymphadenectomy. Conclusion: Merkels tumor is necessary to show the aggressiveness of the disease; is an aggressive neoplasm with high relapse rates. The early identification makes the pathology more curable analysis of risk factors combined with clinical suspicion through surgery, still considered as a first line option since the beginning of follow-up are essential factors for of the disease, promoting overall survival increase in early diagnosis in order to provide a better prognosis patients in general. for the patient.
Contato: Adriano Eduardo Costa de Figueiredo Contato: Maryory Adriana Sánchez Garcia [email protected] [email protected]
TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS CÓDIGO: 88183 CÓDIGO: 87747
MERKEL CELL CARCINOMA: CASE REPORT PARTIAL HEPATECTOMY BY RETROPERITO- Autores: Maryory Adriana Sánchez Garcia / Garcia, NEAL TUMOR WITH HEPATIC INVASION: A MAS / Santa Casa de Porto Alegre; Gustavo Andreazza CASE REPORT Laporte / Laporte, GA / Santa Casa de Porto Alegre; Autores: Barbara Paulo Cavalcante / Cavalcante, B. Gabriela Salzano Silva / Silva, GZ / UFCSPA; Luiz Fillipe P. / Universidade Potiguar; Thiago Costa Pires / Pires, Pinto da Silva / da Silva, LFP / UFSCPA; Giovanni Luigi T. C. / Liga Norte Riograndense Contra o Câncer; Ariza Calvario / Calvario, GLA / Santa Casa de Porto Gustavo Torres Lopes Santos / Santos, G. T. L / Liga Alegre; Cassio Bona Alves / Alves, CB / Santa Casa de Norte Riograndense Contra o Câncer; Lara Valeska de Porto Alegre; Leonardo Cousseau Borges / Borges, LC / Medeiros Rocha / Rocha, L. V. M / Universidade Federal Santa Casa de Porto Alegre; Moacyr Christopher Garces do Rio Grande do Norte; Marjorie Ravena de Oliveira Gamarra Salem / Salem, MCGG / Santa Casa de Porto Pereira Borges / Borges, M. R. O. P / Universidade Alegre; Junior Gil Vicente / Vicente, JG / Santa Casa de Potiguar; Francyjane Emanuela Ferreira Mesquita Silva Porto Alegre; Lucas Gonçalves Matte / Matte, LG / Santa / Silva, F. E. F. M / Universidade Potiguar. Casa de Porto Alegre. Case Presentation: P.S.S., female, 43-years-old, with a Introduction: Merkel cell carcinoma is a rare aggressive significant increase in volume and abdominal pain for neuroendocrine primary cutaneous neoplasia, whose six months, associated with fever, chills, and weight prognosis is poor, and therefore the early diagnosis loss of 4kg. She denies comorbidities and smoking, and is important. There is an increased incidence of this no family history of neoplasms. On examination, she pathology associated with photoexposure areas , had a regular general condition; a globous abdomen, immunosuppression and previous cutaneous malignant distended, with a palpable mass in the hypochondrium neoplasms. It is characterized by a high incidence of and right iliac fossa with poorly delimited contours. local recurrence, involvement of locoregional lymph She had a full abdominal computed tomography nodes and distant metastasis, as well as a high lethality scan showing an expansive pelvic-abdominal lesion rate. Thus, the association of broad primary tumor measuring 19.4 x 19.9 x 15.8 cm, linked to the right resection, regional lymphadenectomy and adjuvant hepatic lobe with signs of infiltration, suggesting radiotherapy has been proposed as a treatment for
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neoplasia, and hypodense hepatic nodules suggesting ramo isquiopúbico; e Tipo IV, ressecção da articulação hemangioma, unable to differentiate between primary sacroilíaca; sendo ainda acrescentado o sufixo H, caso liver tumor and contiguous hepatic infiltration. ocorra a ressecção da cabeça do fêmur. Constituem- Performed an en bloc resection of the abdominal se de procedimentos de alta complexidade, com curva tumor with right colectomy and partial hepatectomy de aprendizado longa, associado à alta morbidade (segments III, IVB, V and VI). Frozen section procedure e elevadas taxas de complicações, bem como suggested hepatocellular carcinoma, whereas the grande impacto funcional e psicológico, devendo ser pathology revealed malignant neoplasia of epithelioid, realizados preferencialmente em centros altamente fusiform and pleomorphic cells, and liver with neoplastic treinados e por equipe cirúrgica multidisciplinar. infiltration. Immunohistochemistry confirmed high- Objetivo: Caracterizar o perfil epidemiológico dos grade pleomorphic spindle cell sarcoma, positive CDK4 pacientes submetidos à hemipelvectomia em serviço and Vimentin, focal marking of smooth muscle actin, de referência. Métodos: Foram utilizados prontuários and may correspond to undifferentiated liposarcoma. dos pacientes e a coleta de dados foi baseada em um Classified as stage T4N0M1, and currently in the second protocolo desenvolvido pelos pesquisadores, que cycle of chemotherapy. Discussion: Retroperitoneal continha as seguintes variáveis: sexo, idade, localização sarcomas are rare and aggressive neoplasms with e tamanho do tumor, presença e local de doença presentation usually in advanced stages. They metastática ao diagnóstico, tipo de cirurgia escolhida, constitute up to one-third of retroperitoneal tumors, características histológicas. Resultados: Observou-se, liposarcoma being the most common histological type. a partir da amostra de 15 pacientes, que houve uma Undifferentiated liposarcoma and undifferentiated proporção aproximada de 2,75 homens para cada high-grade pleomorphic sarcoma often are located mulher (11H-4M), com idade média de 35 anos. A in the thigh and retroperitoneum. Vimentin, the patologia mais frequente foi Osteossarcoma (4 casos), intermediate filament-like protein, helps confirm the seguido de Condrossarcoma (2), Tu Céls Gigantes (2), mesenchymal origin of the tumor. The CDK4, mutual outros Sarcomas (2), Osteocondroma (1) e outros (4); to the differentiated and undifferentiated sarcomas, localizados principalmente em zona I (7 casos), com is considered a highly sensitive lipogenic marker. The tamanho médio de 14cm, sendo a hemipelvectomia principal determinant of therapeutic efficacy is the interna realizada em uma ligeira maioria dos casos (8 Int complete resection of the primary tumor; however, the 7 Ext). Tais resultados são em grande parte semelhantes clinical progression is related to the histological grade à literatura mundial, discordando principalmente and subtype. Final considerations:It is essential for em características em que não se tem um consenso the physician to identify signs and symptoms and to bem estabelecido, em especial o tipo histológico mais know laboratory, imaging, and anatomopathological comum. Conclusão: Estudos epidemiológicos acerca diagnostic tools. Early diagnosis provides effective das hemipelvectomias permanecem raros, mesmo treatment, and greater possibilities for a safe and em grandes centros mundiais. Dessa forma, as efficient surgical approach, improving quality and hemipelvectomias são procedimentos raros, de grande increasing patient survival. morbidade para o paciente, e de grande dificuldade técnica, fazendo-se necessária a realização de estudos Contato: Barbara Paulo Cavalcante mais aprofundados não somente em nossa região [email protected] ou país, mas até mesmo em nível mundial, para que mais profissionais e equipes se aperfeiçoem, gerando melhor capacidade de atendimento à esses pacientes. TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS CÓDIGO: 87243 Contato: Fabio Alves Morikawa Caldeira [email protected] PERFIL EPIDEMIOLÓGICO DE PACIENTES SUBMETIDOS À HEMIPELVECTOMIAS EM TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS SERVIÇO DE REFERÊNCIA ONCOLÓGICA NA CÓDIGO: 87749 AMAZÔNIA ENTRE JANEIRO 2009 JULHO 2019 Autores: Victor Freiras Ferreira / Ferreira, V. F. / PERIPHERAL PRIMITIVE NEUROECTODERMAL Hospital Ophir Loyola; Rafael Maia de Sousa / Sousa, R. TUMOUR: CASE SERIES REPORT AND M. / Hospital Ophir Loyola; Rodrigo Custódio R. Aguiar LITERATURE REVIEW / Aguiar, R. C. R. / Hospital Ophir Loyola; Rodrigo L. F. Santos / Santos, R. L. F. / Hospital Ophir Loyola; Lorena L. Autores: Alexandre Quental Sampaio / Sampaio, A. Q. M. N. Fernandes / Fernandes, L. L. M. N. / Hospital Ophir / HCP; Mário Rino Martins / Martins, M. R. / HCP; André Loyola; Fabio Alves Morikawa Caldeira / Morikawa, F. A. Luiz Marques Marinho / Marinho, A. L. / HCP; Cecília C. / Hospital Ophir Loyola. Araújo C Lima / Lima, C. A. C. / HCP; Luciana Mata / Mata, L. / HCP; Rogerio Bellini Figueiredo Filho / Bellini, Introdução: As Hemipelvectomias são procedimentos R. / HCP; Alison Carvalho Silva / Carvalho, A. / HCP; Steve infrequentes, indicados em uma variedade de Mendes dos Santos / Mendes, S. / HCP. neoplasias pélvicas. Atualmente as hemipelvectomias são classificadas em externas e internas (preservação Introduction: Peripheral primitive neuroectodermal do membro), esta última sendo ainda subdividida tumour (pPNET) is a rare malignant tumour, pela classificação de Enneking e Dunham (ED) corresponding to less than 1% of soft tissue tumours. modificada em: Tipo I, ressecção da asa do ilíaco; Because of this, there has not been established an Tipo II, ressecção do acetábulo; Tipo III, ressecção do universal standard of care. Objective: We aim to
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describe therapeutical markers for patients with I + IIA) en bloc with the muscles iliac and the gluteus pPNET who were treated with different approaches medius and minimus. The pathology revealed grade 2 (neoadjuvant chemotherapy, adjuvant chemotherapy chondrosarcoma measuring 9.2 cm, with free margins. and/or surgical treatment), and correlate them with During follow-up, abdominal CT showed inguinal lymph the best outcomes (disease-free survival and overall node enlargement suggestive of secondary lesions, but survival). We aim to evaluate biomarkers through biopsy showing only reactive hyperplasia. Currently, the immunohistochemistry for future guidance for patient remains in cancer follow-up, without evidence therapeutical goals. Methods: this study describes of disease, being able to support his weight with the the outcomes of patients admitted in a cancer center operated limb. Discussion: The pelvic bones are in Pernambuco between 2015 and 2018. Results: primary sites in less than 5% of malignant bone tumors, Three patients with pPNET were identified, All patients, with chondrosarcoma being the third most common, regardless of the therapeutical approach, have shown after myeloma and osteosarcoma. Despite the high disease recurrence or progression in a short period of therapeutic surgery difficulty due to regional anatomical time - no more than 9 months of disease-free survival. complexity, tumor resection is necessary, making IH Conclusion: Despite of different treatment protocols, a challenging procedure. IH is a surgical modality that none had shown superiority toward the others in terms allows limb preservation with good oncological safety of disease-free survival and overall survival. Further margins, having oncological results similar to external studies are necessary in order to expand the pPNET- hemipelvectomy, but without amputation. IH it is related knowledge, allowing the development of better indicated for smaller tumors restricted to hemipelvis, treatment approaches. without compromising the thigh and without neurovascular invasion of the iliofemoral bundle. In Contato: Cecília Araújo C Lima cases of type I (iliac wing lesions) resection, alike to [email protected] the present case, and type III (ischiopubic lesions), reconstruction is not necessary since the biomechanical alterations caused do not lead to functional losses. TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS Final considerations:IH represents one of the most CÓDIGO: 88003 challenging surgeries for the cancer surgeon. With the evolution of surgical techniques, it is possible to resect PRESERVATION OF LOWER LIMB AFFECTED BY the lesion without the need to amputate the limb, CHONDROSARCOMA THROUGH INTERNAL avoiding deep functional and emotional impacts on the patient. HEMIPELVECTOMY: A CASE REPORT Autores: André Luiz Costa e Silva / Silva, A. L. C. / Liga Contato: André Luiz Costa e Silva Norte Riograndense Contra o Câncer; Thiago Costa [email protected] Pires / Pires, T. C. / Liga Norte Riograndense Contra o Câncer; Luiz Cláudio Jammal Fernandes / Fernandes, L. C. J. / Liga Norte Riograndense Contra o Câncer; TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS Amanda Barbetto Medeiros Torres / Torres, A. B. M. CÓDIGO: 86960 / Liga Norte Riograndense Contra o Câncer; Bárbara Paulo Cavalcante / Cavalcante, B. P. / Liga Norte PSEUDOMYOGENIC HEMANGIOENDOTHE- Riograndense Contra o Câncer; Pedro de Albuquerque LIOMA IN UPPER LIMB: CASE REPORT Mafaldo / Mafaldo, P. A. / Liga Norte Riograndense Contra o Câncer; Victor José Negreiros de Sá Rosado / Autores: Ana Beatriz Tabosa Negrão Xavier / Xavier, Rosado, V. J. N. S. / Liga Norte Riograndense Contra o A.B.T.N / Instituto de Assistência Médica ao Servidor Câncer; Renata Beatriz Bessa Teixeira / Teixeira, R. B. Público Estadual de São Paulo - IAMSPE; Ytauan Barros B. / Liga Norte Riograndense Contra o Câncer; Marina Calheiros / Calheiros, Y.B / Instituto de Assistência Fernandes / Fernandes, M. / Liga Norte Riograndense Médica ao Servidor Público Estadual de São Paulo - Contra o Câncer; Juliana Maria Caetano Nogueira / IAMSPE. Nogueira, J. M. C. / Liga Norte Riograndense Contra o Câncer. Case Report: A 47-year-old female presented with a 3-month history of blackened punctiform lesion Case Presentation: M.J.M., female, 27-years-old, in Tenar eminence of the right hand. That became complained of right hip pain for one month, associated exophytic, whitish and mensured 0.5 cm diameter. with lameness and limitation of movement. No Incisional biopsy revealed a Pseudomyogenic comorbidities or positive family history for cancer. She Hemangioendothelioma, described as a nodular had a pelvic radiograph showing an extra-bony right lesion formed by epithelioid cell sheets, sometimes supra-acetabular expansive lesion. She underwent microvacuolized eosinophilic cytoplasm. No mitoses computed tomography (CT) and magnetic resonance or necrosis were present. Immunohistochemistry imaging of the pelvis, which showed a heterogeneous, stains revealed positive for CD 31, FLI-1, CD64, calcified, vegetative expansive lesion originating CD68 and negative for cytokeratin AE1/AE3, in the right iliac bone, projecting into the iliopsoas CD34, protein S-100, EMA and Desmina. Systemic musculature, with an adjacent peripheral hypodense staging showed no malignancies. The treatment component, measuring 9.1 x 6.6 x 11.0 cm. Lesion was based in obtaning wide margins, (no found biopsy revealed a well-differentiated cartilaginous residual disease). Discussion: Pseudomyogenic tumor. Internal hemipelvectomy (IH) performed with hemangioendothelioma is a neoplasm recognized ileum resection plus acetabular roof resection (type by the World Health Organization since 2013 as an
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intermediate-grade vascular tumor with low potential surgical wound dehiscence and lymphedema. Medical to produce metastases. It is usually presented in imaging revealed extrinsic compression of the femoral males between 20 and 50 years of age and tipically vessels, total obliteration of the vein but no evidence appears in the lower extremities. Clinical presentation of arterial invasion. The surgery was performed is characterized as a firm lump, single or multiple, through conventional access in the right iliac fossa, with measuring less than 3 cm, with undefined margins and resection of the previous surgical scar. External inguinal whitish color. The tumor cells are described as fusiform ring dissection and inguinal lymphadenectomy. Next, arranged in sheets with moderate nuclear atypias right femoral artery and vein proximal dissection with and eosinophilic cytoplasm. In addition, it presents vessel loop repair and identification of femoral nerve structurally similar cells to rhabdomyoblasts that and contact point between the bundle and the tumor. It confer the tumor denomination of “pseudomyogenic”. was performed marginal dissection of the right femoral There are few mitoses and there is usually no artery up to its bifurcation and the right femoral vein necrosis. It has infiltrative pattern involving skin and portion distal to the tumor, as well as repair of the subcutaneous tissue. The relationship between the superficial and deep branches with vessel loop. Section SERPINE1-FOSB fusion Gene and Pseudomyogenic en bloc of quadriceps muscle segment invaded by Hemangioendothelioma is discussed, but still no tumor with 6cm segment of femoral vein compromised diagnostic application. The main differential diagnosis by tumor. Removal of the part, washing of the surgical is the epithelioid sarcoma, the differentiation is wound and exchange of surgical material. The vascular obtained by immunohistochemistry: Pseudomyogenic surgery team chose to suture the right femoral vein. hemangioendothelioma expresses cytokeratin AE1/ Rotation of sartorius muscle flap, correction of inguinal AE3, CD31, EGR, FLI-1 and doesnt express MyoD1, defect and Blake drain. Results: Anatomopathological desmin, protein S-100 and CD34; Epithelioid sarcoma examination confirmed leiomyosarcoma G2 diagnosis, presents positive CD34 and CD31, FLI-1, negative with femoral vein wall invasion, all margins clean. The ERG, and presents central necrosis and higher cellular patient evolved with deep vein thrombosis, edema, atypia. The treatment is the excision of the lesion, lymphorrhea and dehiscence without the bundles although there is still no definition of extension of exposure, due to the integrity of the surgically reopened the resection margins due to the low incidence of sartorius flap. Currently in anticoagulation, with the disease. The disease has a good prognosis, but it vacuum dressing and hyperbaric chamber. Conclusion: has about 58% of recurrence, usually less than 1 year There was no need for arterial reconstruction and after excision. Final comments: We present a report the sarcoma was removed with adequate margins. of pseudomyogenic Hemangioendothelioma with Venous suture option aimed to reduce morbidity atypical presentation, evidencing the importance of owing to previous radiotherapy as an important factor considering it as a differential diagnosis. for complications in STS resection. In order to avoid incomplete resections and the need for reoperations Contato: Ana Beatriz Tabosa Negrão Xavier in more complex situations, is important to approach [email protected] appropriately initial STS.
Contato: Gustavo Takizawa TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS [email protected] CÓDIGO: 87804
RELAPSED SOFT TISSUE SARCOMA WITH TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS FEMORAL VEIN INFILTRATION CÓDIGO: 87978 Autores: Gustavo Takizawa / Takizawa, G. / Universidade RETROPERITONEAL GIANT LIPOMA: A CASE Positivo ; Audrey Tieko Tsunoda / Tsunoda, A. T. / REPORT Hospital Pilar e Hospital Erasto Gaertner; Barbara Dagnoluzzo Moreira / Moreira, B. D. / Hospital Pilar; Autores: Marina Fernandes / Fernandes, M. / Liga Norte Carlos Henrique Trippia / Trippia, C. H. / Instituto de Riograndense Contra o Câncer; Juliana Maria Caetano Roentgen de Curitiba; Ana Helena Willrich Rasera Nogueira / Lira, G. A. / Liga Norte Riograndense Contra / Willrich Rasera, A. H. / LB Anatomia Patológica e o Câncer; Thiago Costa Pires / Pires, T. C. / Liga Norte Citopatologia; Bruno Roberto Braga Azevedo / Azevedo, Riograndense Contra o Câncer; Juliana Maria Caetano Bruno Roberto Braga / Instituto de Hemato Oncologia Nogueira / Nogueira, J. M. C. / Liga Norte Riograndense do Paraná e Hospital Pilar. Contra o Câncer; André Luiz Costa e Silva / Silva, A. L. C. / Liga Norte Riograndense Contra o Câncer; Barbara Paulo Introduction: Soft tissue sarcomas (STS) are a rare Cavalcante / Cavalcante, B. P. / Liga Norte Riograndense set of neoplasms. Therapy is surgical, and it can be Contra o Câncer; Amanda Barbetto Medeiros Torres associated with radio and chemotherapy. In this case / Torres, A. B. M. / Liga Norte Riograndense Contra o of incomplete resection and radiotherapy, there was Câncer; Renata Beatriz Bessa Teixeira / Teixeira, R. B. persistence and local progression. After multidisciplinary B. / Liga Norte Riograndense Contra o Câncer; Pedro meeting, was established indication for surgical rescue. de Albuquerque Mafaldo / Mafaldo, P. A. / Liga Norte Objective: Report a case of relapsed STS with femoral Riograndense Contra o Câncer; Víctor José Negreiros de vein infiltration and discuss the surgical management. Sá Rosado / Rosado, V. J. N. S. / Liga Norte Riograndense Methods: Data were obtained through review of medical Contra o Câncer. records, diagnostic and intraoperative methods and literature review. The patient had a history of previous
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Case Presentation: M.G.C.M., 69-years-old, female, report the experience of the Surgical Oncology Service presented abdominal mass with a gradual volume of the Irmandade da Santa Casa de Misericórdia of Porto increase in 10 years, associated with episodes of Alegre in the treatment of retroperitoneum sarcomas. fever and emesis with food debris. On physical Material and Methods: Retrospective observational examination, superficial and deep abdominal palpation study, through the search of anatomopathological showed a hardened mass occupying mesogastrium, reports, review of medical records and active search of hypochondrium, and left flank. Abdominal and pelvic data from patients operated on this service from May computed tomography revealed a tumor formation of 1 of 2000 to December 31 of 2018, with diagnosis and predominantly fatty attenuation, measuring about 28.2 resection of retroperitoneum sarcoma tumors. Data x 16.2 x 34 cm, extending from the left hypochondrium analyzed using Microsoft Excel and SPSS 25.0. Results to the pelvis and moving the intestinal loops to the and Discussion: 77 retroperitoneum sarcoma surgeries right, benign aspect. Moreover, it was evidenced in the were performed in 30 patients, 13 (43.3%) female and 17 frozen section procedure irregular, elastic, yellowish (56.7%) male, with a mean age of 58.57 years. Of these retroperitoneal lipoma, measuring 38.0 x 33.0 x1 5.0 patients, 21 (70%) were from primary neoplasms, 5 cm. Discussion: The primary retroperitoneal tumors (16.7%) from relapses, 1 (3.3%) from metastatic disease. are rare and have a wide histological variety. They may The most frequent histological types were liposarcoma originate from retroperitoneal, muscular, connective, in 12 (40%), malignant fibrous histiocytoma in 7 (23.3%), lymphatic, nervous, and urogenital tract adipose leiomyosarcoma in 5 (16.7%). As for staging, 5 patients tissue. Retroperitoneal lipomas should be carefully (16.7%) were stage I, 6 patients (20%) were stage II, 14 differentiated from low-grade malignancy liposarcoma (46.7%) at stage III and 5 (16.7%) at stage IV. The mean to provide correct treatment and postoperative 5-year survival rate was 64% at follow-up. Most of the follow-up. Malignant primary retroperitoneal tumors surgically intervened tumors were found to be due to represent less than 1% of all diagnosed malignancies. primary neoplasia. The data presented correspond to Nearly 80% of retroperitoneal tumors are malignant, the medical literature, demonstrating the severity of and, of these, liposarcoma is the most common this pathology. histological type, representing about 45% of cases. However, of the rare benign retroperitoneal tumors, Contato: Gustavo Andreazza Laporte the lipoma is among the most common in adipose [email protected] tissue. Final considerations:Given the above, it is relevant to highlight that retroperitoneal tumors have great varieties of primary sites. Clinical presentation TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS varies according to location, histological type, degree CÓDIGO: 87274 of malignancy, and size. Of benign cases, the lipoma is the most common histological type of adipose tissue RIGHT HIP REGION RHABDOMYOSARCOMA: primary. A CASE REPORT Contato: Pedro de Albuquerque Mafaldo Autores: Laura Pereira Guimarães / Guimarães, L. P. [email protected] / UNIRIO - Universidade Federal do Estado do Rio de Janeiro; Renan Geronimo S. Silva / Silva, R. G. S. / UNIRIO - Universidade Federal do Estado do Rio de Janeiro; TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS Manuella Caroline Dutra Frazão Alves / Frazão, M. C. D. CÓDIGO: 88129 A. / UNIRIO - Universidade Federal do Estado do Rio de Janeiro; Gabrielly Saraiva Porto Garcia / Garcia, G. S. P. RETROPERITONEAL SARCOMA TREATED WITH / UNIRIO - Universidade Federal do Estado do Rio de SURGERY IN AN SURGICAL ONCOLOGICAL Janeiro; Beatriz Escudeiro Nascimento / Nascimento, B. E. / UNIRIO - Universidade Federal do Estado do Rio de SERVICE Janeiro; Antonio Felipe Santa Maria / Santa-Maria, A. F. Autores: Gustavo Andreazza Laporte / Laporte, GAL / / UNIRIO - Universidade Federal do Estado do Rio de Santa Casa de Porto Alegre; José Pio Rodrigues Furtado / Janeiro. Furtado, JPR / Santa Casa de Porto Alegre; Eduardo Dipp de Barros / Barros, ED / Santa Casa de Porto Alegre; Davi Case Presentation A young and black male, resident Carlos Brun / Brun, DC / Santa Casa de Porto Alegre; of Rio de Janeiro, was attended in November 2016. Rodrigo de Pieri Coan / Coan, RP / Santa Casa de Porto He has reported rapid and progressive growth in the Alegre; Leonardo Cousseau Borges / Borges, LC / Santa right gluteal region since 6 months ago. On physical Casa de Porto Alegre; Lucas Gonçalves Matte / Matte, LG examination, a large tumor in the right hip region was / Santa Casa de Porto Alegre; Guilherme Zatti Fedrizzi / noticed, compatible with soft tissue sarcoma (STS). The Fedrizzi, GZ / Santa Casa de Porto Alegre; Cassio Bona lesion measured 20 cm and had no proximity to the Alves / Alves, CB / Santa Casa de Porto Alegre; Moacyr lower limb neurovascular bundles. An incisional open Christopher Garces Gamarra Salem / Salem, MCGG / biopsy has revealed high-grade rhabdomyosarcoma Santa Casa de Porto Alegre. (RMS). Complete resection of the tumor with primary closure with the use of the far-near-near-far suture Introduction: Soft tissue sarcomas are rare neoplasms, was chosen, followed by adjuvant radiotherapy. The comprising less than 1% of all adult malignancies, and postoperative period had a good evolution, however about 10% of these tumors occur in the retroperitoneum one pulmonary nodule (LUL) was found at the end of space, a site difficult to access for diagnostic biopsies, 2017. Pulmonary metastasectomy and chemotherapy and require advanced surgical tactics. Objectives: To with doxorubicin were performed. Currently, the
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patient is being followed without evidence of local or specimen showed fusocellular neoplasia with extensive systemic recurrence. DISCUSSION The STS are rare necrosis and cellular degeneration, compatible with malignant tumors of mesenchymal origin, which evolve previous radiotherapy, constituting soft tissue tumor. with great locoregional and systemic aggressiveness. Surgical limits free of neoplasia. No viable tumor When distant metastases occur, which are more being observed. In the 4th postoperative month, frequent in the lung, they are related to short survival. she presented severe low back pain. CT scan, which RMS arise from precursor cells of skeletal striated identified multiple metastatic lung lesions, inseparable muscle. Biopsy and evaluation of tumor tissue are used sacral implants of the nerve roots, lytic lesion in the for diagnosis. The treatment of choice for these tumors right pubis and iliac region. She was referred to the is surgical, and consists of three-dimensional resection clinical oncology service and due to her performance of the lesion, with wide and free surgical margins. status was considered ineligible for chemotherapy and Radiotherapy (RXT) may be indicated as complementary palliative care was indicated. Discussion: Sarcomas therapy, with greater benefit for high grade poorly are rare tumors, accounting for about 1% of all adult differentiated sarcomas and/or high-volume sarcomas malignancies, most often found in soft tissues. Myxoid (≥10cm). Neoadjuvant RXT (done before surgery) sarcoma is a subtype of liposarcoma, more commonly helps to promote the tumor downsizing and often it found in males and commonly affecting lower limbs. ensures a more radical and less mutilating intervention. Myxoid sarcoma generally has a good prognosis, with Adjuvant radiotherapy (performed after surgery) is overall survival of 90% over five years. Metastases are effective in reducing local recurrence by killing residual unlikely to evolve, which demonstrates the atypia of this cells. As for chemotherapy, it has a response between case, since recurrences - especially bone - are described 20 and 30% in the combination of doxorubicin and in the literature for well-differentiated, high-grade, ifosfamide and it is only used in cases of metastatic pleomorphic neoplasms and occur mainly in the lung disease. Final comments: Surgical management and and liver. Concluding Remarks: Low-grade sarcomas radiotherapy were the treatment of choice for RMS. have a low incidence of metastasis and do not respond Pulmonary metastasis treated with metastasectomy well to chemotherapy. To date, there are no modifiable and chemotherapy had good results until now. risk factors or known forms of prevention. Early diagnosis and treatment at a referral center greatly Contato: Laura Pereira Guimarães improve prognosis. [email protected] Contato: Júlia Raquel Nunes Souza [email protected] TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS CÓDIGO: 87438 TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS SARCOMA ARM MYXOID WITH PULMONARY CÓDIGO: 84397 AND BONE METASTASES: A CASE REPORT SARCOMA DE CÉLULAS FOLICULARES Autores: Júlia Raquel Nunes Souza / Souza, J.R.N. / DENDRÍTICAS EM REGIÃO AXILAR DIREITA: Universidade Federal Fluminense; Danielle Basta Delai / Delai, D.B. / Universidade Federal Fluminense; João RELATO DE CASO EM UM HOSPITAL PÚBLICO Paulo Chevrand Latini de Almeida / Almeida, J.P.C.L. / DO EXTREMO OESTE CATARINENSE Universidade Federal Fluminense; Jonadab dos Santos Autores: Vinicius Negri Dall’inha / DALL’INHA, V. N / Silva / Silva, J.S. / Universidade Federal Fluminense; Igor Hospital Regional Terezinha Gaio Basso - São Miguel do Duque Golçalves da Silva / Duque, I. / Universidade Oeste (SC); Fernando Barbieri / BARBIERI, F. / Hospital Federal Fluminense; Jadivan Leite de Oliveira / Oliveira, Regional Terezinha Gaio Basso - São Miguel do Oeste J.L. / INCA; Marcelo Sá de Araújo / ARAUJO, M. S. / INCA/ (SC); William Casagrande Sanches / SANCHES, W. C. / Universidade Federal Fluminense; Mizael Mascarenhas Hospital Regional Terezinha Gaio Basso - São Miguel / MASCARENHAS Júnior, M. F. / INCA. do Oeste (SC); Mônica Johner / JOHNER, M. / Hospital Regional Terezinha Gaio Basso - São Miguel do Oeste Presentation: A 47-year-old female patient, admitted (SC). to a referral institution in oncology for 10 months, with increased volume in the posterolateral region of the left Introdução: O sarcoma de células foliculares dendríticas arm, of stone consistency, associated with ipsilateral é uma neoplasia extremamente rara. Deriva de um hand pain and paresis. Computed tomography (CT) grupo único especial de células do sistema imune, showed voluminous isodense expansive formation, responsável por oferecer um microambiente favorável with lobed boundaries, located near the left posterior a apresentação de antígenos aos linfócitos B e a criação arm musculature, 14.7x10.5x8.2cm, in contact with da memória imune de tais células e dos Plasmócitos, the adjacent humerus and the corresponding brachial em órgãos linfóides e não-linfóides. Considerada de vessels. Chest CT did not show pulmonary metastases. potencial maligno intermédio, pode afetar gânglios The biopsy diagnosed malignant mesenchymal linfáticos ou locais extraganglionares. Esta lesão é um neoplasia compatible with myxoid sarcoma. She was desafio diagnóstico, e requer confirmação através de referred for neoadjuvant radiotherapy treatment métodos imunohistoquímicos (IHQ). Métodos: Através da (performed in 25 fractions totaling 50Gy), followed by revisão do prontuário, identificou-se paciente feminina, resection of the tumor with immediate reconstruction de 72 anos de idade, apresentando linfonodomegalia with myocutaneous pedicled flap of the dorsalis major axilar direita com evolução há cerca de 4 anos. que muscle. The histopathological report of the surgical devido a outras comorbidades não deu prosseguimento
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a investigação. Há cerca de 3 meses evoluiu com In this context, a surgical resection of the tumor was aumento do volume da nodulação e desconforto local scheduled, with a longitudinal incision following the para movimentação do Membro Superior Direito. Nega thigh axis. An external vessel tumor was identified and outros sintomas constituicionais. Realizou exames established limits with intraoperative ultrasound. The de imagem para elucidação diagnóstica apenas com definitive histopathological report was conventional Tomografia Computadorizada de Tórax evidenciando OSE, chondroblastic, without angiolymphatic invasion, linfonodomegalia axilar direita, medindo 7,2 x 6,4 mitosis present in 10/23 large fields, free margins, cm. Foi submetida a Core Biopsy com diagnóstico de skin free of neoplasia. The patient was referred to an Neoplasia Maligna Indiferenciada e IHQ com suspeita oncology clinic, and either the cisplatin and doxorubicin clínica para Sarcoma de Células Dendríticas Foliculares. chemotherapy regimen was still under surveillance. Optado por Linfadenectomia Axilar Direita Seletiva Discussion: Soft tissue osteosarcoma, also known as da Massa, com diagnóstico definitivo de Sarcoma de extra-skeletal osteosarcoma (OSE), is a rare variant of Céulas Dendríticas Foliculares. Diante da literatura, osteosarcoma, located in soft tissues and organs not optou-se por seguimento oncológico com retorno em 3 commonly present in primary bone osteosarcoma. It meses com exames de imagem. Discussão: Apesar da represents <1% of all sarcomas again and is historically raridadade da doença, as principais séries de pacientes believed to be more aggressive. The prognosis of OSE mostram uma predileção do acometimento linfonodal is poor when compared to intraosseous osteosarcoma. cervical e mediastinal. Podem surgir em outras cadeias More than 80-90% of patients develop local recurrences linfonodais, e também em sítios extra-nodais como and metastases to the lungs and bones. The time cabeça e pescoço, partes moles, mama, fígado, baço, between surgical removal of the primary neoplasia and pele e sistema gastrointestinal. O diagnóstico final recurrence is 2 months to 10 years. Bone osteosarcomas é um desafio por conta de sua raridade, e através de in adolescents and young adults comprise about 15% métodos imunohistoquímicos são descartados dentro of all primary bone tumors and OSE represent 2-5% of do diagnóstico diferencial, doenças como carcinomas, osteosarcomas. Final considerations:OSE is a very rare linfomas, melanoma maligno, sarcoma mielólide, malignant tumor, and there is insufficient evidence for tumores de músculo liso e GIST. A principal modalidade a disease-specific treatment protocol. If management de tratamento é a ressecção cirúrgica, com o papel is performed based on protocols for intraosseous da Radioterapia e Quimioterapia ainda indefinido. osteosarcoma, we follow these applications in this case. Conclusão: Diante da raridade da doença, relatos de caso como o exposto buscam orientar condutas Contato: Ronald Enrique Delgado Bocanegra frente a tais doenças e assim adequar o manejo desses [email protected] pacientes. A ressecção cirúrgica ainda se mantém como o padrão para o tratamento da doença, quando factível. TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS Contato: Vinicius Negri Dall‘Inha CÓDIGO: 88331 [email protected] SOFT TISSUE OF EXTREMITY TREATED IN SANTA CASA DE PORTO ALEGRE TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS CÓDIGO: 85314 Autores: Giovanni Luigi Ariza Calvario / Calvario, GLA / Santa Casa de Porto Alegre; Gustavo Andreazza SOF TISSUE OSTEOSARCOMA : CASE REPORT Laporte / Laporte, GA / Santa Casa de Porto Alegre; AND LITERATURE REVIEW Jose Pio Rodrigues Furtado / Furtado, JPR / Santa Casa de Porto Alegre; Eduardo Dipp de Barros / Barros, ED / Autores: Ronald Enrique Delgado Bocanegra / Santa Casa de Porto Alegre; Leonardo Cousseau Borges DELGADO, RE / HOSPITAL SANTA IZABEL - SALVADOR / Borges, LC / Santa Casa de Porto Alegre; Guilherme / BA; Luis Fernando Pinto Johnson / JOHNSON, LFP Zatti Fedrizzi / Fedrizzi, GZ / Santa Casa de Porto Alegre; / HOSPITAL SANTA IZABEL - SALVADOR / BA; Andre Maryory Adriana Sánchez Garcia / Garcia, MAS / Santa Bouzas de Andrade / ANDRADE, AB / HOSPITAL SANTA Casa de Porto Alegre; Ruth Karina Escobar Díaz / Diaz, IZABEL - SALVADOR / BA; Vitor Savio Melo Costa / RKE / Santa Casa de Porto Alegre; Rosilene Jara Reis / COSTA, VSM / Hospital Santa Izabel - SALVADOR / BA. Reis, RJ / Santa Casa de Porto Alegre; Leticia Pires Viçoza / Viçosa, LP / Santa Casa de Porto Alegre. Case Report: We discuss the case of a married, 35-year-old Brazilian white woman who presented at Introduction: Soft tissue sarcomas are rare neoplasms, the referral hospital for cancer treatment in Salvador comprising less than 1% of all malignant neoplasms in - BA. It had a palpable, voluminous, asymptomatic, adults, and about 50 - 70% of these tumors occur in the slightly mobile mass, approximately 12cm in the right- limbs. The surgical treatment recommended for most thigh latero-proximal region. Imaging studies were tumors is conservative with surgeries of local enlarged performed for mass studies such as staging, showing excision or radical resection, however in some situations a continuous expansive formation in the topography amputations and / or disarticulations are still indicated of the posterior fibers of the vastus lateralis muscle, for locoregional control of the disease. Objectives: To up to the proximal middle level of the right thigh, with report the experience of the Oncology Surgery Service an approximate extension of 10 x 5 x 6cm, without of the Irmandade da Santa Casa de Misericórdia de evidence of disease. in the distance. Ultrasound- Porto Alegre in soft tissue extremity sarcomas. Materal guided thick-needle biopsy was performed and the and Methods: Retrospective observational study, histopathological diagnosis of OSE was obtained. through the search of anatomopathological reports,
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medical records review and active data search of sternum, related to the reconstructive surgical material. patients surgically intervened at the Oncology Surgery The sternum manubrium presented preserved Service of the Irmandade da Santa Casa de Misericórdia morphology and attenuation coefficients. A recent CT de Porto Alegre from May 1, 2000 to December 31, scan showed surgical absence of the sternal body, with 2018, with diagnosis and limb amputation due to soft the presence of a local graft, normal morphology and tissue neoplasia. Data analyzed using Microsoft Excel attenuation, unchanged from the previous exam. The and SPSS 25.0. Results and Discussion: Of these, 56 patient presented a good evolution in one-year follow- (43.8%) were male and 72 (56.3%) female, with a mean up, with no signs of local recurrence. Discussion: age of 49.7 years. The location of the tumors was 23 Chondrosarcoma accounts for 30% of all primary (62.1%) in the lower limb and 14 (37.9%) in the upper malignant bone tumors. This tumor is characterized limb. Fifty-seven amputation surgeries were performed by neoplastic cells, being more frequent in the third in 128 patients, with primary amputations in 20 and fourth decades of life, more common in males. A patients, 7 reamputations and 1 patient submitted to palpable mass, with or without pain, is often the first a third amputation due to tumor recurrence. Eleven symptom. Tumor growth is slow and usually has a hemipelvectomies were performed. The most common benign behavior. Radiologically, the tumor appears histological types were 31 (24.2%) malignant fibrous as a lobulated mass that increases in the medullary histiocytoma, 25 (19.5%) liposarcoma and 17 (13.3%) portion of the bone with destruction of the cortex and undifferentiated tumors. In the group of extremity mineralization of the tumor matrix, which produces an tumors, 39 (30.5%) were in stage I, 14 (10.9%) stage aspect of calcification. The diagnosis is made through II, 68 (53.1%) stage III and 7 (5.5%) stage IV survival. a histopathological and radiographic correlation. 5-year average of 92%, 82%, 64% and 20% respectively. Chondrosarcoma is resistant to radiotherapy and Conclusion: It was found that sarcoma of extremity chemotherapy, which can be explained by its growth is an aggressive tumor, with high local and distant based on matrix production. Therefore, surgical recurrence rates. The results obtained are similar to treatment with resection of the compromised area is other specialized centers. In short, treatment outside recommended. Final considerations:The patient in these centers should be discouraged. question does not show signs of return of tumor activity and, although there is no consensus on the required Contato: Giovanni Luigi Ariza Calvario follow-up after surgery, most authors advocate a [email protected] minimum follow-up of two to five years.
Contato: Mariana Geraldi Rodrigues TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS [email protected] CÓDIGO: 87107
STERNAL PRIMARY MALIGNANT BONE TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS TUMOR: ANTERIOR CHEST WALL CÓDIGO: 88130 RECONSTRUCTION SURGICAL MANAGEMENT OF SOFT TISSUE Autores: Mariana Geraldi Rodrigues / Rodrigues, M. SARCOMAS OF HOSPITAL SANTA RITA G. / Universidade do Vale do Itajaí - UNIVALI; Isabella de Oliveira / Oliveira, I. / Universidade do Vale do Autores: Gustavo Andreazza Laporte / Laporte, GA / Itajaí - UNIVALI; Gabriela Aparecida Schiefler Gazzoni Santa Casa de Porto Alegre; Jose Pio Rodrigues Furtado / Gazzoni, G. A. S / Universidade do Vale do Itajaí - / Furtado, JPR / Santa Casa de Porto Alegre; Eduardo UNIVALI; Vanessa Karlinski Vizentin / Vizentin, V. K / Dipp de Barros / Barros, EDB / Santa Casa de Porto Universidade do Vale do Itajaí - UNIVALI; Bárbara Wiese Alegre; Rosilene Jara Reis / Reis, RJ / Santa Casa de Porto / Wiese, B. / Universidade do Vale do Itajaí - UNIVALI; Alegre; Cassio Bona Alves / Alves, CB / Santa Casa de Guilherme Zappelini Zanette / Zanette, G. Z. / Hospital Porto Alegre; Davi Carlos Brun / Brun, DC / Santa Casa e Maternidade Marieta Konder Bornhausen - HMMKB. de Porto Alegre; Rodrigo de Pieri Coan / Coan, RP / Santa Casa de Porto Alegre; Moacyr Christopher Garces Case Report: Male, 57 years old, complaining of Gamarra Salem / Salem, MCGG / Santa Casa de Porto productive cough and perception of chest injury. Was Alegre; Junior Gil Vicente / Vicente, JG / Santa Casa de referred to a specialist with a diagnosis of sternal Porto Alegre; Lucas Gonçalves Matte / Matte, LG / Santa injury, with computed tomography (CT) showing an Casa de Porto Alegre. expansive formation affecting the entire body of the sternum, with irregular focus of calcification inside. Background: Sarcomas are a heterogeneous group Subtotal sternectomy was performed with thoracic wall of rare tumors that arise predominantly from the reconstruction through two layers of polypropylene embryonic mesoderm. The main treatment of this mesh with inner layer of metamethylcyanoacrylate, pathology is surgical, complemented with radiotherapy using a sandwich technique. The anatomopathological and chemotherapy in selected cases. Objetives: Describe study of intraoperative freezing of the surgical margins the clinical, pathological characteristics and survival of guaranteed their negativity and revealed to be a surgical patients intervened with soft tissue sarcoma Class 1 Central Chondrosarcoma (pT1). The patient Methodology: Historic cohort study from May 2000 to remained with a portovac drain in the surgical site and December 2018 of the patients who were submitted to bilateral chest drain, which were removed in the 3rd surgical treatment for soft tissue sarcoma. Results: This postoperative period. The imaging study after subtotal series has 254 patients (145 women) with an average sternectomy showed hyperattenuating material in the age of 51,58 years. Our service performed 179 surgeries
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for primary lesions patients, 53 procedures for recidive is performed alone. About 2 to 3% of the cases, pulmonary lesions patients and 14 for metastasis lesions patients. metastases may be occur. Clinically presents pain, edema The most common localisation is the limbs (50,4%), and limitation of movement. Usually they affect the followed by the trunk (34,3%) and retroperitoneum epiphyseal of the long Bones.Surgery is the treatment of (11,8%). We performed 71 radical surgeries, with choice. For resectable intraosseous lesion , curettageis 57 amputations, 11 hemipelvectomies and 3 pelvic recommended, followed by filling with bone cement. exenterations. The histopathological type most For patients with potentially resectable disease, but with common is liposarcoma (18,9%) followed by malignant bad ECOG or when The proposed surgery adds a lot of fibrous histiocytoma (17,3%), and leiomiosarcoma morbidity, the denosumab can be considered. Our patient, (11,4%). This series has 75 cases in Stage I, 33 cases in young, obese, with locally advanced disease, benefited Stage II, 128 cases in Stage III and 18 in Stage IV, with from neoadjuvant treatment, which Allow less aggressive 5-year survival of 95%, 90%, 70% and 38%, respectively. surgical treatment. Although there may be a higher risk of Conclusions: Our epidemiological and survival results recurrence due to the conservation of the bone segment, are similar to the literature. The overall survival of this the immunobiological effect ensures a Better systemic series is influenced by the high incidence of advanced control of the disease.Final Comments:Denosumab is tumours (Stage III). effective in symptomatic and functional improvement, capable of maintaining TCG stability, and well tolerated by Contato: Gustavo Andreazza Laporte patients. Considers the an excellent strategy for the cases [email protected] of recurrent or locally advanced disease, allowingTless aggressive surgical ratting.
TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS Contato: Myra Jurema da Rocha Leão CÓDIGO: 85382 [email protected]
SURGICAL TREATMENT OF GIANT CELL TUMOR GRADE III OF CAMPANACCI IN LOWER TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS CÓDIGO: 87436 LIMB AFTER DOWSTAGING BY DENOSUMAB Autores: Myra Jurema da Rocha Leão / Leão, M.J.R. / TIKHOFF-LINBERG PROCEDURE FOR THE Santa Casa de Misericórdia de Maceió; Luís Renato TREATMENT OF SCAPULA CHONDROSARCOMA: de Lima Pedrosa / Pedrosa, L.R.L. / Santa Casa de CASE REPORT AND LITERATURE REVIEW Misericórdia de Maceió; Aldo Vieira Barros / Barros, A.V. / Santa Casa de Misericórdia de Maceió; Daniel Autores: Manuella Caroline Dutra Frazão Alves / FRAZÃO Menezes Tenório Cavalcante / Cavalcante, D.M.T. / ALVES, M. C. D. / Universidade Federal do Estado do Rio Santa Casa de Misericórdia de Maceió; Robson da Silva de Janeiro - UNIRIO; Beatriz Escudeiro Nascimento / Pereira / Pereira, R.S. / Santa Casa de Misericórdia de NASCIMENTO, B. E. / Universidade Federal do Estado Maceió; Pool Anibal Alarcon Leon / Leon, P.A.A. / Santa do Rio de Janeiro - UNIRIO; Danielle Rodrigues Neves Casa de Misericórdia de Maceió; Nikolas Nascimento de da Costa / COSTA, D. R. N. / Universidade Federal do Almeida / Almeida, N.N. / Santa Casa de Misericórdia de Estado do Rio de Janeiro - UNIRIO; Gabrielly Saraiva Maceió. Porto Garcia / Garcia, G. S. P / Universidade Federal do Estado do Rio de Janeiro - UNIRIO; Kaique Torres Case Presentation: J. S.S., woman, 22 years old, obese. Fernandes / FERNANDES, K. T. / Universidade Federal History of falling from its own height in Jan/2018, do Estado do Rio de Janeiro - UNIRIO; Laura Pereira attending a pathological fracture of the left tibia. The Guimarães / Guimarães, L. P. / Universidade Federal radiography has showed evidence of pathological fracture do Estado do Rio de Janeiro - UNIRIO; Leonardo Cruz of the proximal tibia, in addition to an osteolytic lesion, Gomes / GOMES, L. C. / Universidade Federal do Estado no sclerosis halo in the Episio-metaphyseal region with do Rio de Janeiro - UNIRIO; Vanessa Veronica Brocki posterior cortical rupture and invasion of soft tissues. Oliveira / BROCKI, V. V. O. / Universidade Federal do She was referred to the oncological Surgery Outpatient Estado do Rio de Janeiro - UNIRIO; Antonio Felipe Santa Clinic. In the opportunity, we performed the percutaneous Maria Coquillard Ayres / Santa-Maria AF / Universidade biopsy of the lesion. After the confirmed histopathological Federal do Estado do Rio de Janeiro - UNIRIO. diagnosis of giant cell tumor (TCG) in the proximal tibia, an imaging examination was requested for clinical A 65-year-old white male patient with C-virus liver staging: Chest tomography , which evidenced absence cirrhosis reports a rapidly growing, progressive right of disease at distance. In view of the case of TCG grade shoulder tumor for 9 months. Difficulty in raising right III of Campanacci, with a view to optimizing Surgical arm above shoulder line, tumor fixed to deep planes, treatment, a neoadjuvant treatment with denosumab was without cutaneous ulceration and hardened consistency. chosen 120 mg SC for 6 months. The patient presented CT showed a 16 cm tumor in the right scapula, without progressive pain decrease and volumetric reduction compromising the axillary vessels or brachial plexus. As of 60% of the lesion. She was subjected to curettage of for staging, there were no signs of metastatic disease. the lesion, followed by electrocauterization and Bone Tikhoff-Linberg (TLP) procedure was performed without cement. The young woman follows ambulatory follow- the use of prosthesis or bone fixations after resection. up, with excellent functional outcome. Discussion: Giant The patient presented acceptable oncological and cell tumor is a Bone Neoplasia osteolytic, rare, benign, cosmetic outcomes. In the postoperative period, he but locally aggressive, in young adults. It may be locally presented incapacity of right shoulder movement, aggressive and the disease may recur when the curettage but the mobility and strength of the right hand were
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preserved, and about 50% of the forearm function was eixo. Indicado tratamento cirúrgico. No intra-operatório maintained. Histopathological report attested low grade 23/08/18, observou-se invasão tumoral de veia cava chondrosarcoma in the scapula, resected with free impossibilitando ressecção à R0, interrompendo cirurgia. margins. After 3 years of follow-up, the patient died of liver Optou-se por iniciar tratamento com denosumabe, failure, with no signs of sarcoma recurrence. TLP consists fazendo 4 ampolas de 60 mg/ml por mês em setembro of resection of the entire shoulder girdle (humerus e outubro de 2018, reduzindo para 2 ampolas mensais head, scapula and lateral third of the collarbone). This de novembro de 2018 até o presente momento. RM de is a not common surgery pratice, which denotes the controle realizada após oito meses de tratamento revelou relevance of this study to the literature, which has a tumoração com características osteolíticas, medindo 7,0 review of the theme and case report with description x 4,55cm em maior e menor eixo, localizada e restrita of the procedure. Due to the low incidence of scapular ao osso sacro, observando-se regressão sintomática tumors, there are no prospective, multicenter and long- completa da paciente. Discussão: Os tumores de células term studies evaluating it for invasion of the chest wall gigantes são neoplasias benignas agressivas, mais and presence of lymph node metastasis. TLP is indicated comuns em mulheres com 30/35 anos. Desencadeiam under two circumstances: (1) radiological evidence reabsorção óssea por osteoclastogênese através da of non-invasion of axillary and subclavian vessels ativação do RANKL. O tratamento típico é através de and (2) non-tumoral involvement of brachial plexus ressecção cirúrgica, podendo ter difícil abordagem a nerves. In these situations, loss of innervation and / or depender de sua localização, além de recidivas em até vascularization would render the limb unusable Tumor 35% dos casos. A FDA (Food and Drug Administration) invasion due to chest wall contiguity and lymph node liberou em 2013 o uso do denosumabe, um anticorpo involvement are criteria of worse prognosis and make monoclonal inibidor da osteoclastogênese, como the indication of PTL questionable. Many patients with alternativa do tratamento cirúrgico de TCG irressecáveis scapular waist tumors are still undergoing interscapulo- ou sequelantes. No caso relatado a paciente apresentava thoracic disarticulation, in which the entire upper limb is um tumor sem possibilidade de cirurgia à R0, sendo removed. This report aims to foster the discussion of a beneficiada e apresentando bom resultado com uso da little known and used surgical procedure, but which may droga. Comentários finais: O uso do denosumabe vem mean the preservation of the upper limb in these cases. apresentando resultados promissores no tratamento de Despite losing arm function, the patient retained the TCG. A droga tem capacidade de reduzir o tamanho do ipsilateral forearm and hand functions that would have tumor, sendo boa opção neoadjuvante e em casos de been amputated in a less conservative surgery. impossibilidade cirúrgica.
Contato: Manuella Caroline Dutra Frazão Alves Contato: Ricardo Restivo de Castro Teixeira [email protected] [email protected]
TEMÁRIO: SARCOMAS / TUMORES ÓSSEOS TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 87150 CÓDIGO: 87553
TUMOR DE CÉLULAS GIGANTES SACRAL ANALYSIS OF CLINICAL AND SURGICAL IRRESECÁVEL - TERAPIA COM DENOSUMABE PROFILE OF ESOPHAGEAL CANCER PATIENTS Autores: Ricardo Restivo de Castro Teixeira / RESTIVO, OPERATED AT A REFERENCE HOSPITAL IN R.C.T. / Hospital Araújo Jorge; Carlos Henrique Ribeiro SOUTHERN BRAZIL Do Prado / Prado, C.H.R. / Hospital Araújo Jorge; Luiz Autores: Aniúsca Vieira dos Santos / Santos, AV Gustavo Ferreira dos Santos / Santos, F.G.L. / Hospital / Universidade Federal de Ciências da Saúde de Araújo Jorge; Thaís Brandão Cozac / Cozac, T.B. / Puc Porto Alegre - Grupo de Pesquisa Translacional em - Goiás; Jandra Evangelista / Evangelista, J. / Hospital Oncologia (GPTO); Andreas Timóteo Lutz / Lutz, AT / Araújo Jorge; Marcelo Aron Alves Freitas / Aron, M.A.F. Irmandade da Santa Casa de Misericórdia de Porto / Hospital Araújo Jorge; Diego Henrique Barros da Silva Alegre - Grupo de Pesquisa Translacional em Oncologia / Barros, D.H.S. / Puc Goiás; Daniel de Paula Santana / (GPTO); Plauto Erasmo Beck / Beck, PE / Irmandade da Santana, D.P. / Hospital Araújo Jorge. Santa Casa de Misericórdia de Porto Alegre - Grupo de Pesquisa Translacional em Oncologia (GPTO); Apresentação do caso: S.M.A.F. 42 anos, mulher, Maiquidieli Dal Berto / Dal Berto, M / Universidade previamente hígida iniciou, em dezembro de 2016, Federal de Ciências da Saúde de Porto Alegre - Grupo parestesia leve em membros inferiores, evoluindo para de Pesquisa Translacional em Oncologia (GPTO); paraparesia intensa e impossibilidade de deambulação. Gabriela Krüger da Costa / Costa, GK / Irmandade da Associado a obstipação intestinal e retenção urinária. Santa Casa de Misericórdia de Porto Alegre - Grupo Em setembro de 2017 após biópsia percutânea, com de Pesquisa Translacional em Oncologia (GPTO); diagnóstico anatomopatológico tumor de células Camila Tombini Silveira / Silveira, CT / Irmandade da gigantes (TCG) sacral foi encaminhada ao Hospital Santa Casa de Misericórdia de Porto Alegre - Grupo de Araújo Jorge - GO tendo primeira consulta em abril Pesquisa Translacional em Oncologia (GPTO); Antônio de 2018. Realizado Ressonância Magnética (RM) que Nocchi Kalil / Kalil, AN / Irmandade da Santa Casa de revelou volumosa lesão lítica em sacro, acometendo as Misericórdia de Porto Alegre; Antonella Jacobsen Kaul asas ilíacas, arco vertebral de L5, musculatura glútea; / Kaul, AJ / Universidade Federal de Ciências da Saúde compressão de órgãos pélvicos e proximidade com vasos de Porto Alegre - Grupo de Pesquisa Translacional em ilíacos; lesão medindo 12 por 10cm em maior e menor Oncologia (GPTO); Rafael José Vargas Alves / Vargas, RJA
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/ Irmandade da Santa Casa de Misericórdia de Porto Silva / SILVA, L.M. / Hospital de Câncer de Pernambuco; Alegre - Grupo de Pesquisa Translacional em Oncologia Bruno Guido de Vasconcellos Goes / GOES, B.G.V. / (GPTO); Claudia Giuliano Bica / Bica, CG / Universidade Hospital de Câncer de Pernambuco; André Luiz de Sousa Federal de Ciências da Saúde de Porto Alegre - Grupo Lima / LIMA, A.L.S. / Hospital de Câncer de Pernambuco; de Pesquisa Translacional em Oncologia (GPTO). Sergio Ricardo Soares de Moura / MOURA, S.R.S. / Hospital de Câncer de Pernambuco; Danielle Godoy Introduction: Esophageal cancer is the eighth most Magalhães / MAGALHAES, D.G. / Hospital de Câncer de frequent in the world, usually diagnosed in late phases Pernambuco; Mario Rino Martins / MARTINS, M.R. / Real and of extremely aggressive nature. Several risk factors Instituto de Cirurgia Oncológica. favor the carcinogenic process. In Brazil there are about 10,790 new cases of the disease and 8,402 deaths per year. Introduction: Perioperative chemotherapy was However, differences are observed due to ethnic factors successfully introduced as standard of care for locally and geographical distribution, being more frequent in the advanced gastric adenocarcinoma. Most recently, the southern region of the country. Objective: Analysis of the FLOT4 trial demonstrated superiority of the FLOT (5- clinical and surgical profile of patients with esophageal FU, leucovorin, oxalipatin and docetaxel) in comparison cancer. Methods: Retrospective cohort, including patients with standard regimen. However, objective parameters diagnosed with esophageal cancer with surgical treatment for measuring tumor response are lacking in the clinical between 2012 and 2017. The study was approved by the practice. Histopathological tumour regression grading Research Ethics Committees of the institutions involved has proven to be an useful and objective parameter for and is in accordance with Resolution CNS 466/2012. assessing tumor response to neoadjuvant chemotherapy. Results: A total of 126 patients were evaluated, of which Objective: We aim to assess histopathological tumour 92 (73%) were males, with a mean age of 63 years (41-87 regression grade to neoadjuvant FLOT regimen and its years, standard deviation of 9.7). Regarding the histological effectiveness in patients with gastric adenocarcinoma. type of neoplasia, we identified a higher frequency of Methods: Its an ongoing study, with two steps: first, squamous cell carcinoma (63.5%) than adenocarcinoma we conducted a retrospective analysis of patients who (36.5%) of the esophagus. Primary surgery was performed have undergone neoadjuvant chemotherapy with in 80.2% of the patients, and 19.8% of the patients FLOT between march 2018 and february 2019; next were to neoadjuvant therapy with radiotherapy and we included patients treated between march 2019 and chemotherapy. Of these, 20% (5 patients) had a complete august 2020, aiming to evaluate histopathological tumour pathological response. The tumoral location in 44.4% of regression according to the American College of Pathology the cases were in esophageal gastric transition, 30.9% classification.Results: We obtained as preliminary results, were located in the middle third of the thorax and 23% as it is an ongoing study: 16 patients were submitted to in the lower third. As for the histological grade, 57.2% of neaodjuvant FLOT between march 2018 and february the lesions were grade 2 and 34.1% grade 3. Analyzing the 2019. Pathological complete response (pCR) rate was 6,2%, clinical stage (EC), the most prevalent were EC II (42.8%) while pCR in the FLOT4 trial was 16% (p=NS). We obtained and EC III (34.1% %), and 8 patients (6.3%) were EC IV on absence of tumour regression in 37,5% of patients. Our pathological evaluation. Among the types of surgery, the study was inferior to FLOT4 trial in ressecability (62,5% x most frequent procedure was transhiatal with 43.6% of 94%, p<0,05) and ressecability R0 (50% x 85%, p<0,001). the cases, followed by transthoracic surgery with 41.2% The rate of surgical complications was 30%. There was (24 conventional, 21 endoscopic and 7 mixed) and total no surgical mortality. Conclusion: The histopathological gastrectomy plus esophagectomy, with 5.5% of cases. The tumour regression to FLOT in gastric adenocarcinoma mean time of the surgical procedures was 411.32 min patients in our hospital was lower than the FLOT4 results. (161-805 min). 36% of the patients presented recurrence Our study was inferior in ressecability and ressecability R0 of disease (14 patients with local recurrence, 29 with rates. Neoadjuvant FLOT did not increase morbidity and relapsing at distance and 3 both). The median survival mortality in our hospital. was 18.5 months, with the mean follow-up period being 48 months. In addition, 16 (12.9%) of the patients died Contato: Cecília Araújo Carneiro Lima within the first 30 postoperative days. Conclusion: The [email protected] high rate of relapse and mortality of the patients analyzed reflects the importance of new methodologies for the early diagnosis of esophageal cancer. TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 87136 Contato: Plauto Erasmo Beck [email protected] ANÁLISE DO USO DE GOMA DE MASCAR NO AUXÍLIO DA REALIMENTAÇÃO PRECOCE EM
TEMÁRIO: TRATO GASTROINTESTINAL ALTO PÓS-OPERATÓRIO DE GASTRECTOMIAS CÓDIGO: 87720 Autores: Nathaly Russo N dos Santos / dos Santos, NRN / ACCamargo Cancer Center; Thais Manfrinato ANALYSIS OF HISTOPATHOLOGICAL TU- Miola / Miola, TM / ACCamargo Cancer Center; Felipe MOUR REGRESSION IN PATIENTS WITH GAS- José Fernandez Coimbra / Coimbra, FJF / ACCamargo TRIC ADENOCARCINOMA SUBMITTED TO Cancer Center; Wilson Luiz da Costa Jr / da Costa, WL Jr / ACCamargo Cancer Center. NEOADJUVANT FLOT IN A CANCER CENTER Autores: Cecília Araújo Carneiro Lima / LIMA, C.A.C. / Introdução: pacientes submetidos à cirurgia abdominal Real Instituto de Cirurgia Oncológica; Luciana Mata da comumente apresentam íleo pós-operatório (IPO)
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devido à extensa dissecção, exaustão pós-operatória e UDE exam was performed having identified a lesion of longa duração da anestesia, levando à dor abdominal, infiltration character with diffuse bleeding, initiating náuseas, vômitos, atraso na ingestão oral e internações juxtacardya, on the small curvature, becoming a prolongadas. Na cirurgia abdominal, existem circumference in medio and distal body, extending evidências de que a goma de mascar possa reduzir until the body and antrum transition, suggestive of o IPO, estimulando a recuperação precoce da função advance gastric neoplasia (Borrmann IV). The result gastrointestinal. No entanto, achados contraditórios em was of a conclusive anatomopathologic Diffuse outros estudos refutam os efeitos da goma de mascar. Adenocarcinoma poorly differentiated. Admitted in Além disso, a maioria dos estudos anteriores foram the service of oncology and during the hospitalization realizados após cirurgia colorretal ou ginecológica, period it evolved with the persistency of upper digestive enquanto poucos relatos focaram no efeito da goma hemorrhage, thrombocytopenia and lymphocitarire de mascar após gastrectomia. Objetivo: avaliar o uso dissociation with cell formation until promyelocytes, de goma de mascar na influência do retorno precoce suggesting the possibility of marrow invasion as a da dieta no pós-operatório de gastrectomia. Materiais paraneoplasic syndrome. It received transfusion e Métodos: o estudo foi do tipo retrospectivo e support, countless concentrates blood cells, platelets observacional que comparou 31 indivíduos que usaram and cryoprecipitate, besides unsuccessful hemostatic goma de mascar no período do jejum pré-operatório radiotherapy. During follow-up and hospitalization a com 104 indivíduos que não utilizaram. Os pacientes PET CT was conducted with the detection of an increase incluídos no estudo foram submetidos à gastrectomia on glycolytic metabolism in perigastric lymph nodes, on total e subtotal. As variáveis avaliadas foram o estado lung hilum, left para-iliac and external iliac, additionally nutricional através do IMC (Índice de Massa Corpórea), bone marrow uptake. Considering the unprecedented reintrodução precoce da dieta e complicações cirúrgicas bone marrow uptake a biopsy was chosen and e infecciosas. Resultados: a amostra foi composta por demonstrating in anatomopathologic results and 59,3% de homens e 40,7% de mulheres. A gastrectomia immunohistochemistry, gastric carcinoma metastasis. total foi realizada em 47,4% dos indivíduos. De acordo Patient developed neutropenia, skin focused sepses and com o IMC, a maioria (41,5%) da amostra se encontrava death. In Brazil, gastric cancer in the third most frequent em eutrofia, enquanto 19,3% estavam desnutridos. As among and the fifth among women. Adenocarcinoma complicações cirúrgicas foram presentes em 17% dos is a kind of cancer that has secretarial characteristics, indivíduos, enquanto que as complicações infecciosas origin from glandular tissues and which are responsible ocorreram em 22,2%. Não houve diferença significativa for 95% stomach tumor cases. If not diagnosed early, para a reintrodução precoce da dieta com o uso ou gastric cancer starts growing rapidly, forming mucous não da goma de mascar no pré-operatório (p=0,203). O ulcers, penetrating deeper layers of the stomach and uso da goma de mascar não apresentou influência nas even invading neighbor organs, such as esophagus, complicações cirúrgicas (p=0,102) e nas complicações duodenum, pancreas and spleen. This article reports an infecciosas (p=0,463) Conclusão: o uso da goma de unusual case, extremely rare, and without the accounts mascar não mostrou benefícios para a realimentação described so far, the bone marrow metastases of precoce no pós-operatório. Mais estudos são gastric cancer de diagnosed after a clinical status of necessários para avaliar os possíveis benefícios em blood dyscrasia and imaging exam by PET CT. Despite pacientes gastrectomizados. the interest on this being such an unprecedented and curious clinical scenario, this case presents a bleak Contato: Thais Manfrinato Miola prognosis due to the aggressiveness of the tumor and [email protected] the patients clinical condition.
Contato: Gabriel da Rocha Bonatto TEMÁRIO: TRATO GASTROINTESTINAL ALTO [email protected] CÓDIGO: 87863 TEMÁRIO: TRATO GASTROINTESTINAL ALTO BONE MARROW METASTASIS BY GASTRIC CÓDIGO: 88348 CANCER Case Report: GRADE II NEUROENDOCRINE Autores: Max Wellington Satiro Justino / Satiro, M. W. TUMOR OF THE ILEUM J. / Hospital de amor de barretos; Gabriel da Rocha Bonatto / Bonatto, G. R. / Hospital de amor de barretos; Autores: Ana Clara Vieira Alexandre / Alexandre, Ana Lidio Carvalho da Silva Lima / Carvalho, L. S. L. / Hospital Clara V. / FAG; Janaina Gatto / Gatto, Janaina / FAG; Julio de amor de barretos; Paulo Victor Fortes Sampaio / Zanini / Zanini, Julio / UOPECCAN; Ivana dos Santos Fortes, P. V. S. / Hospital de amor de barretos; Durval Willington / Willington, Ivana / FAG; Nathalia Kauka Renato Wohnrath / Wohnrath, D. R. / Hospital de amor Cardoso / Cardoso, Nathalia k. / FAG; Gabriel Brisot / de barretos; ênio David Mente / Mente, E. D. / Hospital Brisot, Gabriel / UOPECCAN; Diego Aparecido Gaspar / de amor de barretos; Fernando Ernesto Cruz Felippe / Gaspar, Diego / UOPECCAN. Felippe, F. E. C. / Hospital de amor de barretos; Diego Burgardt / Burgardt, D. / Hospital de amor de barretos; Case description: A.G.S, 63 years old, female, with Marcos Aurélio Sanctis / Sanctis, M. A. / Hospital de symptoms of chronic abdominal pain, performed amor de barretos. investigation with total abdominal ultrasound which showed abdominal mass. Segmental enterectomy Patient, 27, male, presenting an episode of epigastralgia of the ileum region was performed and referred for three months, evolving with hematemesis episodes. for follow-up at the service due to the diagnosis of
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Neuroendocrine Tumor. No complaints. Pathology treatment for 24 cycles, until October 2015 there was showing Neuroendocinus Tumor Grade II - ileum 20 progression of disease in the left lung, and the same x 15 mm, free margins. Patient remains under follow- regimen was resumed. From December 2015 to up at the service. Discussion Neuroendocrine tumors January 2019, the patient maintained stable disease (ENT) are neoplasms derived from entercromaffin cells, during chemotherapy, with no evidence of liver injury. which have the ability to produce neurotransmitter, Discussion: Surgical resection of colorectal liver neuromodulatory and neuropeptide hormones. It metastasis offers a greater chance of cure and long- does not have a standard symptomatology, varying term survival, therefore being the therapy of choice according to the endocrine production profile and in resectable metastases. For those with isolated tumor location, which causes difficulties for a diagnosis diseases, regional treatment approaches may be based on the clinical picture. ENT can cause Carcinoid considered as an alternative or in combination with Syndrome (CS), but is uncommon, the predominant systemic chemotherapy. Available regional treatments symptom is Flushing, which manifests with paroxysmal include regional liver resection, chemoembolization, facial, neck and chest erythema. Most of these tumors radioembolization and radiotherapy. Although liver are well differentiated and slow growing. However, due resection was reserved for patients with a maximum to the difficulty in recognizing symptoms, most of the of three lesions in the same lobe, if it was possible to time, the diagnosis is at an advanced stage and the reach 1 cm margins and those without lymph node prognosis is generally unfavorable compared to other metastases, these rules were modified with advances gastrointestinal endocrine tumors. Treatment consists in surgical technique and systemic therapy. As a result, of extensive resection of the lesion and extensive the criteria for defining which patients are suitable for excision of the regional lymphatic drainage territory, surgical therapy have evolved, and many surgeons even for small lesions. Considerations Because it is an take an aggressive stance in the management of liver insidious disease, patients with neuroendocrine tumors metastases. Final comments: The reported case opens are often referred to a specialized service late. It is often the way for discussion of the role of multimodal therapy referred after surgery in an emergency service, due to in cases of high volume liver disease in colorectal the difficulty of signs and symptoms of the disease. metastasis, where with the advancement of surgical techniques and chemotherapy, we can elect patients Contato: Ana Clara Vieira Alexandre who are candidates for more aggressive therapy, [email protected] bringing benefit in quality of life and survival.
Contato: Rivaldo Serrano de Andrade Neto TEMÁRIO: TRATO GASTROINTESTINAL ALTO [email protected] CÓDIGO: 88184
CASE REPORT: IMPORTANCE OF MULTIMODAL TEMÁRIO: TRATO GASTROINTESTINAL ALTO TREATMENT AS A CONVERSION THERAPY IN CÓDIGO: 87547 HIGH VOLUME HEPATIC DISEASE PATIENTS CASE REPORT: LATE POSTOPERATIVE ARTERIAL IN COLORRETAL METHASTS HEMORRHAGE AFTER FULL ROBOTIC Autores: Rivaldo Serrano de Andrade Neto / NETO, GASTRECTOMY WITH D2 LYMPHADENECTOMY R. S. / AC CAMARGO ; Cicero Diego Soares Santos / SANTOS, C. D. S. / AC CAMARGO; Andre Luis de Godoy Autores: Thiago de Almeida Furtado / Furtado, T. A. / / GODOY, A. L. / AC CAMARGO; Alessandro Landskron Hospital Felício Rocho e Faculdade Ciências Médicas Diniz / DINIZ, A. L. / AC CAMARGO; Wilson Luiz da Costa de Minas Gerais; Fernando Augusto de Vasconcellos Juunior / JUNIOR, W. L. C. / AC CAMARGO; Silvio Melo Santos / Santos, F. A. V. / Hospital Felício Rocho e Torres / TORRES, S. M. / AC CAMARGO; Igor Correia de Faculdade Ciências Médicas de Minas Gerais; Paula Farias / FARIAS, I. C. / AC CAMARGO; Guillermo Manozzo Vidigal Assumpção / Assumpção, P. V. / Faculdade Trevisol / TREVISOL, G. M. / AC CAMARGO; Felipe Jose Ciências Médicas de Minas Gerais; Victor Guerra Fernandez Coimbra / COIMBRA, F. J. F. / AC CAMARGO; Campos / Campos, V. G. / Faculdade Ciências Médicas Heber Salvador de Castro Ribeiro / RIBEIRO, H. S. C / AC de Minas Gerais; Victória Mara Vieira Rocha / Rocha, CAMARGO. V. M. V. / Faculdade Ciências Médicas de Minas Gerais; Diego Paim Carvalho Garcia / Garcia, D. P. C. / Hospital Case Report: We report the case of a 33-year-old Felício Rocho e Faculdade Ciências Médicas de Minas female patient, diagnosed in June 2013 with rectal Gerais; Mariana Sala de Faria e Silva / Silva, M. S. F. / adenocarcinoma, wild kras, with more than 40 liver Hospital Felício Rocho; Cyntia Ferreira dos Reis / Reis, C. metastatic nodules. She underwent conversion F. / Hospital Felício Rocho. chemotherapy treatment with FOLFOX + BEV, followed by rectosigmoidectomy + enucleation of Case Report: G.A.A., a 44-year-old male patient, without 12 and alcoholization of 3 liver lesions in October comorbidities, diagnosed with gastric adenocarcinoma 2013, and continued systemic treatment. In January and preoperative staged as cT2N2M0. He underwent 2014, portal vein embolization was performed, and in neoadjuvant treatment with Flot 4 protocol, without March of the same year she underwent right hepatic lesion regression. Full robotic gastrectomy with D2 trisegmentectomy, with persistent disease in 3 nodules. lymphadenectomy and transmesocolic Roux-en-Y Started scheme with FOLFIRI + CETUXIMABE, and in reconstruction were performed. The patient presented June 2014 radiofrequency performed on 2 remaining small complications fully solved throughout the lesions, with good response. Continued chemotherapy postoperative care. At the 18th POD, he presented
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hemodynamic instability associated with tarry stools differentiated gastric adenocarcinoma. Computed and hematic secretion in abdominal drains. He tomography showed asymmetric parietal thickening underwent emergency exploratory laparotomy. A large of the stomach with radiological signs of invasion of hemoperitoneum was identified as a result of bleeding the pancreatic body and left lateral liver segments, in the left gastric artery stump, with closed hemolocks without suspicious lymph nodes. Staging laparoscopy found close. It was possible to stop the bleeding, with showed no evidence of peritoneal disease, macroscopic improvement of hemodynamic parameters, which invasion of left lateral liver segment, and peritoneal was not sustained, worsening the patient‘s condition whas was negative. She started neoadjuvant treatment and leading him to death. Discussion: Postoperative with FLOT regime but stopped after third cycle due arterial hemorrhage is a possible complication of to gastric bleeding and signs of local progression complex procedures, such as full gastrectomy with D2 (bulky tumor). CT scan showed progressive disease, lymphadenectomy, which occurs in 1.9 to 2.6% of cases still resectable with a multivisceral resection. After and has a mortality rate close to 30%. It is classified into multidisciplinary team discussion, patient was taken to early postoperative arterial hemorrhage, which occurs OR in June, 6th, 2019, where a gastric mass with liver, within the first 24 hours after the procedure and late spleen, pancreas and retroperitoneal involvement was postoperative arterial hemorrhage, that occurs after found with no evidence of metastatic disease. A total this period, as in the reported case. Late postoperative gastrectomy plus D3 lymphadenectomy with left lateral arterial hemorrhage has two major etiologies: artery hepatic segmentectomy along with total splenectomy erosion due to primary complication and/or possible and distal pancreatectomy was performed. The OR arterial wall injury during lymphadenectomy. The vessels time was eight hours, estimated blood loss 500 ml. most commonly affected in postoperative arterial Patient recovered well, being discharged on the July, hemorrhage after gastrectomy are derived from the 8th, 2019. Final pathology came with a ypT4b ypN2, with coeliac trunk. There are risk factors for postoperative a microscopic positive margin to retroperitoneo along arterial hemorrhage, such as age > 70 years, male with aorta anterior surface. The patient presented with gender, BMI > 25, prolonged surgical time and resection early recurrence to skin and amygdala, being referred of other organs. Patient with postoperative arterial to immunotherapy (pembrolizumab). Discussion: hemorrhage after gastrectomy may present bright red Locally advanced gastric cancer is an aggressive disease massive bleeding in the abdominal drain and/or upper and multidisciplinary treatment (surgery and systemic or lower gastrointestinal bleeding, with a hemoglobin treatment) has been the standard of care. Tumors with drop, severe abdominal pain and hemodynamic MSI-H represents less than 10% of patients with this instability. The treatment for late postoperative clinical presentation and the role of systemic treatment hemorrhage depends on the patient‘s diagnosis and has been questioned both in the neoadjuvant and hemodynamic status. It is possible to try an approach adjuvant scenarios for those patients. Although a through interventional radiology or surgical approach. prospective data regarding the best approach for such Final comments: Robotic oncologic surgeries are safe patients is lacking, many groups have reserved those and effective, but not completely free of complications, patients for a surgical approach only, due to a better as in the reported case, with a late postoperative prognosis showed in subgroup analysis in randomized arterial hemorrhage, which is rare but quite severe and studies. Final comments: Our case exemplify an complex to manage. aggressive biological behavior of a MSI-H gastric adenocarcinoma showing the challenge in clinical Contato: Paula Vidigal Assumpção practice such cases still represent and the need for [email protected] prospective data to determine its best approach.
Contato: Valter Junio Fiuza Machado TEMÁRIO: TRATO GASTROINTESTINAL ALTO [email protected] CÓDIGO: 88349
CASE REPORT: MULTIVISCERAL RESECTION TEMÁRIO: TRATO GASTROINTESTINAL ALTO FOR MSI-H GASTRIC ADENOCARCINOMA PRO- CÓDIGO: 87096 GRESSING ON NEOADJUVANT TREATMENT CASO CLÍNICO DE UM GIST ESOFÁGICO DE Autores: Valter Junio Fiuza Machado / Machado, V. J. F. / COMPORTAMENTO ATÍPICO AC Camargo Cancer Center; Alessandro Landskron Diniz / Diniz, A. L. / AC Camargo Cancer Center; André Luís Autores: Amanda / Feltrin, A. Z. / CEPON; Eduardo de Godoy / Godoy, A. L. / AC Camargo Cancer Center; Zanella / Zanella, E. / CEPON; Renan Deprá Camargo / Héber Salvador de Castro Ribeiro / Ribeiro, H. S. C. / AC Camargo, R. D. / CEPON; Rodrigo Baretta / Baretta, R. / Camargo Cancer Center; Igor Correia de Farias / Farias, CEPON; Jean Ricardo Silvestre / Silvestre, J. R. / HSJ. I. C. / AC Camargo Cancer Center; Silvio Melo Torres / Torres, S. M. / AC Camargo Cancer Center; Wilson Luiz O tumor estromal gastrointestinal (GIST) é o subgrupo da Costa Júnior / Costa Jr, W. L. C. / AC Camargo Cancer mais comum dos tumores mesenquimais ou estromais. Center; Felipe José Fernandez Coimbra / Coimbra, F. J. F. São neoplasias subepiteliais que podem acometer / AC Camargo Cancer Center. todo o trato gastrointestinal, mas a localização mais comum é no estômago e no intestino delgado proximal. Case Report: We report a case of a 68-years-old Raramente ocorrem em pacientes com menos de 40 female patient diagnosed in February, 2019 with a cT4b anos. A maioria dos casos ocorre esporadicamente, (liver and pancreas) cN0 HER-2 negative, moderately porém 5% possuem alguma síndrome autossômica
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dominante associada, como por exemplo a abdominal de início há 7 dias, com piora importante nas neurofibromatose. A sintomatologia é inespecífica, ultimas 24hs, associada à febre e taquicardia. Ao exame como saciedade precoce e inchaço, e muitos deles apresentava-se com abdome reativo. À tomografia assintomáticos. Porém, podem crescer o suficiente (TC) de abdome notava-se liquido livre em cavidade para sangrar ou obstruir. A biópsia só é recomendada e distensão líquida importante do estômago excluso. em caso de suspeita de doença metastática ou se Paciente então foi submetida à laparotomia exploradora considerar o uso de imatinib pré-operatório em com achado de úlcera perfurada em fundo gástrico. doença localmente avançada. V. V. M., masculino, 61 Além de grande quantidade de secreção gástrica livre anos. Iniciou com disfagia e perda de peso com piora e abscessos intracavitários. Com lesão endurecida, progressiva. EDA: lesão vegetante e friável em esôfago causando estenose antro-pilórica no estômago excluso. distal (30cm ADS) ocupando 1/3 da circunferência Foi realizada ulcerorrafia, biópsia da lesão antral e ampla do órgão, estendendo-se até a transição esôfago drenagem da cavidade, devido gravidade da paciente gástrica. Anatomopatológico: neoplasia fusocelular. e ausência de diagnóstico oncológico prévio. No dia Imunohistoquímica compatível com tumor estromal seguinte o resultado da análise histopatológica veio como gastrointestinal (GIST). Na tomografia observa-se lesão adenocarcinoma com células em anel de sinete. Após expansiva em esôfago distal, insinuando-se para base 7 dias de terapia nutricional e antibioticoterapia para do hemitórax esquerdo medindo aproximadamente tratamento da sepse abdominal a paciente foi submetida 13 x 11 x 13cm. Realizou neoadjuvância com imatinibe a gastrectomia total + esôfagojejujo anastomose, e após 6 meses a tomografia apresentou redução da sem alteração no Y prévio. Evoluiu satisfatoriamente lesão 91 x 73mm, porém, agora, em contato com face no pós operatório, com presença de coleção liquida posterior do pericárdio, aorta descendente e hemicúpula na TC de controle, puncionada de forma percutânea diafragmática esquerda, determinando compressão guiada por USG, de aspecto serohemático. Recebeu parênquima pulmonar. Realizado esofagectomia alta no 16º po da gastrectomia total e permanece em com gastrectomia parcial em fevereiro de 2019. seguimento oncológico ambulatorial. Discussão: A Anatomopatológico confirmou GIST com margens incidência de adenocarcinoma gástrico em pacientes livres de tamanho 8 x 7 x 8cm. Imunohistoquímica pós gastrectomia redutora à Fobi-Capella é rara. Nos positivo para CD34, CD117, DOG1, SMA. Os tumores últimos 10 anos, pouco mais de 30 casos foram descritos mesenquimais constituem aproximadamente 1% na literatura, destes, a maioria no estômago excluso. O das neoplasia primárias gastrointestinais, sendo que método diagnóstico de maior sensibilidade é endoscopia destes menos de 1% localiza-se no esôfago. A maioria digestiva alta (EDA), entretanto a dificuldade de acessar o deles são diagnosticados com 5cm de diâmetro, porém estômago excluso pós by pass gástrico acaba por atrasar de localização gástrica. Não há relatos da média de o diagnóstico precoce nesses pacientes. Comentários tamanho de GIST esofágico. Uma revisão sistemática finais: Apesar de rara, a incidência de câncer gástrico que compreendeu 29 estudos com mais de 13.550 nos pacientes submetidos à gastroplastia redutora paciente em 19 países, concluiu que a idade mediana tente a aumentar, em parte pelo envelhecimento dessa é em torno de 60 anos, localização mais comum no população pós bariátrica. A dificuldade de acessar o estômago (55,6%), apenas 0,7% no esôfago, e incidência estômago excluso via endoscopia e atribuição da dor de 10-15 por milhão/ano. Com isso, evidencia-se a abdominal, que costuma ser o sintoma mais precoce, ao raridade do caso descrito acima, visto que o tamanho próprio procedimento cirúrgico prévio tende a atrasar não habitual, sua localização atípica e a neoadjuvância o diagnóstico. Faz-se cada vez mais necessário pensar indicada para pacientes selecionados, demonstram a no câncer gástrico nessa população como diagnóstico diversidade do caso. diferencial e aprimorar maneiras de se rastrear o estomago excluso e diagnosticar precocemente. Contato: Amanda Zampolli Feltrin [email protected] Contato: Fabio Alves Morikawa Caldeira [email protected]
TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 87829 TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 88140 CÂNCER GÁSTRICO DE ESTÔMAGO EXCLUSO EM PACIENTE PÓS GASTROPLASTIA CLINICAL AND SOCIO-DEMOGRAPHIC REDUTORA PROFILE OF ESOPHAGEAL AND STOMACH NEOPLASIA AT A BRAZILIAN ONCOLOGY Autores: Fabio Alves Morikawa Caldeira / Morikawa, F. A. M. / Hospital Ophir Loyola; Victor Freitas Ferreira / CENTER Ferreira, V. F. / Hospital Ophir Loyola; Rodrigo Custódio Autores: Marina Oliveira Dias / DIAS, M. O. / Faculdade R. Aguiar / Aguiar, R. C. R. / Hospital Ophir Loyola; de Ciências da Saúde - Dr Paulo Prata FACISB; Fundação Lorena L. M. N. Fernandes / Fernandes, L. L. M. N. / Pio XII - Hospital de Câncer de Barretos; Taysa Machado Hospital Ophir Loyola; Rodrigo L. F. Santos / Santos, Menezes / Menezes, T. M. / Fundação Pio XII - Hospital R. L. F. / Hospital Ophir Loyola; Patrícia Isabel Bahia de Câncer de Barretos; Ricardo dos Reis / Reis, R. / Mendes Freire / Freire, P. I. B. M / Hospital Ophir Loyola. Fundação Pio XII - Hospital de Câncer de Barretos; Jorge Elias Junior / Junior, J.E / Faculdade de Medicina de Apresentação do caso: Paciente 40 anos, sexo feminino, Ribeirão Preto - FMRP USP; Fabiano Rubião Lucchesi / com história de gastroplastia redutora à Fobi-Capella há Lucchesi, F.R. / Fundação Pio XII - Hospital de Câncer de 14 anos. Deu entrada na urgência queixando-se de dor Barretos; Raphael Leonardo Cunha de Araújo / Araújo,
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R.L.C. / Escola Paulista de Medicina - UNIFESP; Fundação do Amazonas; Leandro Castro Breves / Breves, L.C Pio XII - Hospital de Câncer de Barretos; Departamento / Universidade do Estado do Amazonas; Renata de Oncologia Americas Serviços Médicos. Maravieski Pareja / Pareja, R.M / Universidade do Estado do Amazonas; Rejaine Ribeiro Vilela / Vilela, JUSTIFICATION: In 2018, stomach cancer was responsible R.R / Universidade Nilton Lins; Sarah Susan Rodrigues for almost 780 million deaths worldwide and, in that same Tavares / Rodrigues, S.S / Universidade Federal do year, more than 500 million deaths have occurred due to Amazonas; Angeli Alexandra Caro Contreras / Contreras, esophageal cancer. Therefore, knowing the clinical and A.A.C / Universidade do Estado do Amazonas; Amanda socio-demographic profile of these patients seems to be Laís Menezes Puigcerver Pascual / Pascual, A.L.M.P / useful. Although, there are few epidemiological studies Universidade do Estado do Amazonas; Sidney Raimundo on these tumors. Objectives: To describe the clinical and Chalub / Chalub, S.R / Fundação Centro de Controle de socio-demographic profile of patients diagnosed with Oncologia do Estado do Amazonas. stomach and esophageal cancer at a oncology center held by the Unified Health System (Sistema Único de Saúde Introduction: According to the statistical data proposed SUS). Methodology: Prospective study with a sample of by the National Cancer Institute (INCA), the incidence of 80 patients with stomach cancer (n = 49) or esophageal gastric cancer for Brazil in 2018 was 13,540 among men cancer (n = 31). Sociodemographic data, tumor staging, and 7,750 in women. In Amazonas, it was the second laboratory tests (hemoglobin (g/dL), transferrin (mg/dL) most common cancer in men, and the fifth in women. and albumin (g/dL)) were collected and anthropometric Objective: To draw a clinical and epidemiological profile evaluation was also executed. The RedCap platform was of stomach tumors treated at Fcecon, in order to know used and the database was collected from January/17 the predominant histological type, the anatomical to July/18. Results: Male prevalence was observed for sublocation and to relate the socioeconomic level with the both diagnoses (57.1% for stomach with a mean age of degree of staging of the patients. Methodology: We used 57.4 years, and 77.4% for esophageal with a mean age of a descriptive, cross-sectional, quantitative, retrospective 60.1 years; in the last one, the mean age for the female study using medical record review and hospital registry patients was of 50,4 years. In both diagnoses, there was a information in a reference unit in oncology in the Amazon. prevalence of white adults (79.6% for stomach and 58.1% Results: The research involved 221 gastric cancer patients for esophageal), followed by black adults (16.3% and treated at the institution from May 2018 to April 2019. 35.5%, respectively). Most of the patients had incomplete About 34% of patients underwent gastrectomy. Regarding primary education (40.8% of patients with stomach cancer the operated patients, approximately two thirds (63.3%) and 51.6% of esophageal). Regarding the anthropometric were male, with an average of 62.1 years for men, and parameters, gastric tumors had a weighted median of 57.9 for women, with the majority (63.5%) had low 64.7kg, and a BMI (kg/m2) of 23.71, with severe weight loss socioeconomic status. Regarding sublocation, the stomach in 38.8%. For esophageal tumors, weighted median was body was the most affected region in 43.2% of the cases. 68.7kg, BMI was 26.1, with severe weight loss in 32.2%. Regarding the histological type, epithelial neoplasms The medians of biochemical parameters for stomach represented 85.7%, and 70.0% adenocarcinoma. and esophageal cancer were, respectively, hemoglobin According to Lauren‘s classification, the intestinal type was 13.3 and 13.1, transferrin 265 and 225 and albumin 3.9 more frequent. In neoplasms with informed staging, the for both. The 80 patients had a Karnofsky Performance vast majority (77.7%) was considered very advanced (III Status (KPS) range between 100 and 80. Almost 26.5% or IV). Conclusion: There is evidence of different statistics of stomach cancer patients were diagnosed at stage IA comparing socioeconomic status, patient age, anatomical and 16.3% at stage IIIC. Whereas, 19.4% of the patients sublocation and histological type of tumor. Thus, it was with esophageal cancer were diagnosed at stage 0 and observed that stomach neoplasms make up an extremely 19.4% at IIB. Conclusion: At our hospital, stomach and essential part when compared to all neoplasms treated esophageal cancers are more prevalent on white men over at this service and follow the profile described in the 55 years old and with low education. Patients presented literature regarding anatomical sublocation, histological at diagnosis severe weight loss. Biochemical parameters type, staging age, sex and educational level match eutrophy in both cases. There was a considerable percentage of patients with late-stage cancer at diagnosis. Contato: Lailson Melgueira Navarro [email protected] Contato: Marina Oliveira Dias [email protected] TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 88226 TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 87948 COLONIC INTERPOSITION AFTER ESOPH- AGOGASTRECTOMY IN THE TREATMENT CLINICAL-EPIDEMIOLOGICAL PROFILE OF OF CANCER OF THE ESOPHAGOGASTRIC STOMACH NEOPLASMS OF PATIENTS SUB- JUNCTION: CASE REPORT MITTED TO GASTRECTOMY IN THE FOUNDA- TION OF THE AMAZON STATE ONCOLOGY Autores: Diego Windson de Araujo Silvestre / SILVESTRE, D.W.A. / SANTA CASA DE MISERICÓRDIA DE MACEIÓ; Aldo CONTROL CENTER - FCECON IN 2018 Vieira Barros / Barros, A.V. / Santa Casa de Misericórdia de Autores: Lailson Melgueira Navarro / Navarro, L.M / Maceió; Filipe Augusto Porto Farias de Oliveira / Oliveira, Universidade do Estado do Amazonas; Larissa Pessoa F.A.P.F. / Santa Casa de Misericórdia de Maceió; João de Oliveira / De Oliveira, L.P / Universidade Federal Bruno Ribeiro Machado Lisboa / Lisboa, J.B.R.M. / Santa Casa de Misericórdia de Maceió; Wander Mattos Cardoso
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/ Cardoso, W. M. / Santa Casa de Misericórdia de Maceió; D. / Hospital Erasto Gaertner; Julia Goginski / Goginski, J. / Amanda Lira dos Santos Leite / Leite, A.L.S. / Santa Casa de Hospital Erasto Gaertner; Vinicius Basso Preti / Preti, V.B. Misericórdia de Maceió; Tainá Santos Bezerra / Bezerra, T.S. / Hospital Erasto Gaertner; Raphaella Ferreira / Ferreira, / Santa Casa de Misericórdia de Maceió; Thiago Yamamoto R. / Hospital Erasto Gaertner; Phillipe Abreu / Abreu, Amaral / Amaral, T.Y. / Santa Casa de Misericórdia de P. / Hospital Erasto Gaertner; Flavio Daniel Saavedra Maceió; Gustavo Mendonça Ataíde Gomes / Gomes, G. M. Tomasich / Tomasich, F.D.S. / Hospital Erasto Gaertner. A. / CESMAC; Igor Lima Buarque / Buarque, I. L. / CESMAC. Summary Objective: To compare clinical characteristics Case Report: A 62-year-old male patient with dysphagia and indicators related to the surgical treatment of gastric and weight loss, diagnosed with GII adenocarcinoma at the cancer between patients submitted to Total Gastrectomy esophagogastric junction with extension to the terminal and those submitted to Partial Gastrectomy. Method: esophagus (Siewert III cardia tumor), cT3N + M0 staging, Retrospective descriptive comparative study. For patients ECIII. Undergoing neoadjuvant chemotherapy with FLOT with stomach cancer who underwent lymphadenectomy scheme showing partial response to restaging exams. With with D2 lymphadenectomy during the period from jan- indication of total gastrectomy and distal esophagectomy, 2005 to jul-2015 at Hospital Erasto Gaertner, Curitiba-PR. the patient was taken to surgery. Intraoperatively, it Patients were allocated to the groups Total Gastrectomy was observed that the tumor extended from the small and Partial Gastrectomy. And the statistical analyses gastric curvature to the middle esophagus at the level always took place in a comparative manner between the of carina. Aiming at free margins, the surgical strategy groups. The data were submitted to several statistical was modified and total gastrectomy was performed analyses, being p<0.05 considered statistically significant. with esophagectomy of the lower 2⁄3, with interposition Results: Of the total of 396 patients, 123 (31%) underwent of the right isoperistaltic colon for reconstruction of Total Gastrectomy, 273 (69%) Partial Gastrectomy. When the alimentary transit. On the 16th postoperative day, age, gender, BMI, Performance Status, Anesthetic Risk the patient developed esophagocholonic anastomosis (ASA), and laboratory tests were analyzed, there was no fistula, treated conservatively by thoracoscopy with cavity statistically significant difference between the groups. lavage and drainage. Without further complications, the The most frequent histological type was adenocarcinoma. patient was discharged on the 36th postoperative day. And the staging data were similar between the groups. Discussion: The intraoperative distinction of the real The surgical time was significantly longer in the total extent of esophageal involvement did not change its gastrectomies 240 minutes, against 180 minutes in the staging, but the extent of resection. It is postulated that partial ones. Postoperative complications occurred in 23 Siewert III tumors should be considered as gastric cancer, (18.7%) patients of the Total Gastrectomy group versus requiring additional esophageal resection for adequate 35 (12.8%) patients of the Partial Gastrectomy group, margins. The reconstruction of esophagocholosplasty not reaching statistical relevance. On the other hand, the transit becomes complex as an unplanned procedure, need for reoperation was significantly greater in the Total exacerbating its disadvantages: the need for two more Gastrectomy group, 19 (15.4%) patients versus 22 (8.1%) in anastomoses than for small bowel reconstruction, the Partial Gastrectomy group. Death within 30 days was longer surgical time and postoperative morbidity. Final higher in Total Gastrectomy 3.8% versus 2.5% in Partial considerations:It is noteworthy that even with reliable Gastrectomy. The mean length of stay, as well as the daily staging methods and rigorous surgical technique, there stays in the ICU were longer for Total Gastrectomy. The may be anatomo-radiological dissociation of the lesions. number of lymph nodes dissected showed no difference The report shows that although the postoperative between the groups. The mean overall survival was period is complex and that therapeutic conversion was 7.14 years (5.90-8.38) in patients submitted to total and performed during the procedure, it is evident that colonic 9.31 years (8.47-10.15) in the partial, with a significant interposition esophagogastrectomy provided the capacity statistical difference (p=0.01). Compared to 5 years, for tumor resection with maintenance of oncological the overall survival was significantly higher for Partial principles. Gastrectomy, 74% versus 56%. Conclusions: Patients submitted to total gastrectomy have worse results in Contato: Diego Windson de Araujo Silvestre relation to partial gastrectomy. Primary tumor size, lymph [email protected] node involvement, surgical time and severe postoperative complications requiring reoperation are the main factors influencing the overall survival of patients. TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 87680 Contato: Luiza Mesquita Barbosa [email protected] COMPARATIVE ANALYSIS OF SURGICAL OUTCOMES AND OVERALL SURVIVAL TEMÁRIO: TRATO GASTROINTESTINAL ALTO BETWEEN TOTAL AND PARTIAL CÓDIGO: 88086 GASTRECTOMY IN GASTRIC CANCER: 396 CASES IN A SINGLE INSTITUTION COMPARISON OF ESOPHAGOJEJUNAL Autores: Luiza Mesquita Barbosa / Barbosa, L.M. / ANASTOMOSIS IN ROBOTIC SURGERY Hospital Erasto Gaertner ; Ewerson Luiz Cavalcanti Silva AND LAPAROSCOPIC DURING SURGICAL / Silva, E.L.C. / Hospital Erasto Gaertner; Regina Maria MANAGEMENT OF GASTRIC CANCER Goolkate / Goolkate, R.M. / Hospital Erasto Gaertner; Thamyle Moda Santana Rezende / Rezende, T.M.S. / Autores: Fernando Augusto de Vasconcellos Santos / Hospital Erasto Gaertnert; Danilo Saavedra / Saavedra, Santos, F.A.V. / Faculdade Ciências Médicas de MInas
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Gerais; Diego Paim / Paim, D. / Faculdade Ciências Background: Neoadjuvanttreatment (NT) for pancreas Médicas de Minas Gerais; Mariana M Garcia / Garcia, head cancer (PHC) may allow some patients to undergo M.M. / Faculdade Ciências Médicas de Minas Gerais; curative resection, but its impact on postoperative Andre Bicalho / Bicalho, A. / Faculdade Ciências Médicas complications remains unclear. Methods: A systematic de Minas Gerais; Thiago de Almeida Furtado / Furtado, review and meta-analysis was made based on Medline, T.A. / Faculdade Ciências Médicas de Minas Gerais; Embase and Scopus databases, comparing overall Ana Paula Drummond-lage / Drummond-Lage, A.P. / postoperative morbidity, pancreatic fistula, and mortality Faculdade Ciências Médicas de Minas Gerais; Alberto between patients who undergo upfront surgery (US) vs Julius Alves Wainstein / Wainstein, A.J.A. / Faculdade NT followed by pancreaticoduodenectomyfor patients Ciências Médicas de Minas Gerais. with PHC. Risk ratio (RR) for morbidity and mortality rates in comparative (CS) and non-comparative studies Introduction: Gastric Carcinoma (GC) is considered (NCS) were made. Results:Fifty-one studies were the second leading cause of death by cancer in the included (34 NCS and 17 CS) totalizing 2,938 pattients, world. The total gastrectomy is considered a complex NT:1,396 (47.5%), and US: 1,542 (52.5%). The morbidity surgical procedure and has, due to its esophagojejunal ranges in CS were 9.9 98% in SU vs 5.6 96.7% in NT. anastomosis, one of its main causes of surgical morbidity Mortality rates ranges were respectively SU 0 7.7% and and mortality. Laparoscopy and, more recently, robot- NT 0 10.2%. No statistical differences for morbidity and assisted laparoscopic surgery have been used more mortality rates were detected in CS (RR 0.99 95% CI 0.74 widely in the surgical treatment of Gastric Carcinoma to aid 1.32 and RR 0.6 95% CI 0.28 1.32). The morbidity rate decrease such complications.Objective: To compare the for NCS was6.0% (95% CI 18 39%). The mortality rates technical differences of esophagojejunal anastomosis in of NCS ranged from 0 to 5.1%. NT favors decreasing robotic and laparoscopic surgery in patients undergoing of pancreatic fistula rates in RR 0.64 (95% CI 0.5 0.82, total gastrectomy for curative treatment of GC. Method: p=0.001) in the fixed model with heterogeneity of 55%, Retrospective analysis of charts of patients submitted to however, in a random model, this difference was not total laparoscopic and robotic access gastrectomy for seen (RR 0.72 95% CI 0.47 1.09, p=0.12) Conclusion: the treatment of CG, from 2017 to 2019, with emphasis This systematic review with meta-analysis for CS and on esophagojejunal anastomosis techniques.Results: NCS did not find any statistical differences in overall Ten patients were included in the laparoscopic group morbidity and mortality associated with NT for PHC. and 12 in the robotic group. The reconstruction of intestinal transit after gastrectomy was performed by the Contato: Raphael de Oliveira e Silva Roux-en-Y technique in all cases. Regarding the robotic [email protected] surgical procedures, the esophagojejunal anastomosis was performed by manual suture, with aid the use of endostaplers. In the laparoscopic group, on average, four TEMÁRIO: TRATO GASTROINTESTINAL ALTO loads of staplers were used to make the esophagojejunal CÓDIGO: 88206 anastomosis and Roux-en-Y, while in the robotic group, two loads were used for the same purpose. The robotic EPIDERMOID ESOPHAGEAL CANCER WITH group presented with no esophagojejunal anastomosis CUTANEOUS AND PERITONEAL METASTASIS: fistulas or leakage. The laparoscopic group, presented A RARE PRESENTATION with one case of anastomotic fistula. In all cases, a sentinel drain was placed next to the esophagojejunal Autores: ágata Rothert / ROTHERT, A. / HOSPITAL SÃO anastomosis.Conclusion: Esophagojejunal anastomosis VICENTE; Priscila Nunes Silva Morosini / MOROSINI, after total gastrectomy can be safely performed either P. N. S. / HOSPITAL SÃO VICENTE; Mariana de Castro laparoscopically or by robotic. The latter is made using / CASTRO, M. de / HOSPITAL SÃO VICENTE; Marcela fewer endostapler loads, which may impact the final Santos Cavalcanti / CAVALCANTI, M. S. / HOSPITAL costs of surgical treatment of this condition. SÃO VICENTE; Marciano Anghinoni / ANGHINONI, M. / HOSPITAL SÃO VICENTE. Contato: Fernando Augusto de Vasconcellos Santos [email protected] Presentation: A female patient, 64 years old, with hypertension, diabetes and alcoholism, was admitted with progressive dysphagia, weight loss and high TEMÁRIO: TRATO GASTROINTESTINAL ALTO cervical pain in last 3 months. She was submitted to CÓDIGO: 88139 a gastrointestinal endoscopy and the diagnosis of a stenosing lesion in superior esophagus, 18cm from DOES NEOADJUVANT TREATMENT FOR upper dental arch. The histopathological diagnosis PANCREATICHEAD ADENOCARCINOMA was an epidermoid esophageal cancer. On CT, was INCREASE POSTOPERATIVE MORBIDITY? observed a lesion with 3,1cm of length, on anterior wall of esophagus, without cleavage plan with the trachea. SYSTEMATIC REVIEW AND META-ANALYSIS Also, was present several enlarged lymph nodes. After Autores: Raphael Leonardo Araujo / R. L. C. Araujo a multiprofessional meeting, was decided to manage / UNIFESP; Raphael de Oliveira e Silva / R.O.Silva / the patient with chemotherapy and radiotherapy Hospital marcio cunha; Cristiano de Pádua Souza / exclusively. During the treatment, an alternative C.P.Souza / Hospital de Câncer de Barretos; Florence feed way was need, and a jejunostomy was proceed. Huguet / F.Huguet / Hôpital Tenon , France; Sebastien During this operation, was observed several peritoneal Gaujou, / S.Gaujou / Hôpital Cochin, France; Jean Michel implants, causing small bowel obstruction. Therefore, Milani / J.M.Milani / unifesp. an enterectomy was proceed. The histopathological
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study showed metastatic epidermoid carcinoma in fat Discussion: Esophageal GCT are rare and accidentally tissue and in mesenteric lymph nodes. Simultaneously, discovered in endoscopy related to other complaints. cutaneous nodes in nose, scalp and left flank appeared They have a predilection for women in their fourth and and, again, the histopathological study showed fifth decade of life, although they can be discovered metastatic epidermoid carcinoma. The patient had at any age. Most lesions are single, benign, located in disease progression despite the treatment, and died the middle and distal esophagus, in the muscularis 7 months after first contact with an oncology team. mucosa or submucosal layer of the esophagus. They Discussion: Cutaneous metastasis from a esophageal are commonly confused with leiomyomas, lipomas and epidermoid carcinoma are really rare, affecting only 1% cysts. These tumors consist of spindle and compact of all histological kinds. Usually it is a metachronic event, polygonal nest cells with dark nuclei and abundant with a 2 or 3 years of progression of the disease. The eosinophilic granular cytoplasm. S100 protein positive pattern of spreading on this patient is atypical, mainly immunohistochemistry, neuron specific enolase during the treatment. Final comments: only rare cases and nestin are common. They may rarely have a of cutaneous spreading of esophageal epidermoid malignant course, usually being masses larger than carcinoma was reported, and none with this features. 4 cm with rapid growth, invasion of local structures The peritoneal spreading is another rare presentation. and recurrence after resection. Presence of necrosis, The combination between this two features make a high mitotic index and nuclear grade are evidences in rare situation, probably associated with high aggressive favor of malignancy. Endoscopic ultrasound is a useful histological tumors. technology for deciding the management of GCT. The best management is controversial. Endoscopic Contato: Ágata Rothert follow-up for asymptomatic lesions smaller than 1 cm, [email protected] endoscopic resection for lesions between 1 and 2 cm and surgical excision for tumors larger than 2 cm and symptomatic patients are generally recommended. TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 88153 Contato: Pedro Henrique Mendes Figueiredo [email protected] ESOPHAGEAL GRANULAR CELL TUMOR: RARE CASE AND LITERATURE REVIEW TEMÁRIO: TRATO GASTROINTESTINAL ALTO Autores: Pedro Henrique Mendes Figueiredo / CÓDIGO: 88154 Figueiredo, P.H.M. / Instituto de Oncologia Santa Paula; Eduardo Petribu / Petribu, E. / Instituto de Oncologia ESOPHAGUS ABRIKOSSOFF TUMOR - A RARE Santa Paula; André Luís de Freitas Perina / Perina, A.L.F. REPORT / Instituto de Oncologia Santa Paula; Sérgio Dias Do Couto Netto / Couto Netto, S.D. / Instituto de Oncologia Autores: Layane Barreto Costa / Costa, L. B. / Santa Paula; Carolina Baraúna Assumpção / Assumpção, Universidade Potiguar; Isaac Braulio Maia Delfino C.B. / Instituto de Oncologia Santa Paula; Frederico José Oliveira / Oliveira, I. B. M. D. / Liga Norte Riograndesse Ribeiro Teixeira Júnior / Teixeira Júnior, F.J.R. / Instituto Contra o Câncer; Lucas Solon Dias de Farias / Farias, L. de Oncologia Santa Paula; Tibério Moura de Andrade S. F. / Universidade Potiguar; Daniely Pessoa Moreira / Lima / Lima, T.M.A. / Instituto de Oncologia Santa Paula; Moreira, D. P. / Universidade Potiguar; Luiz Frederico Felipe D‘almeida Costa / Costa, F.D. / A.C. Camargo Bezerra Honorato Júnior / Honorato Júnior, L. F. B. / Cancer Center. Universidade Potiguar; Lucas Paschoal Silva / Silva, L. P. / Universidade Potiguar; Francimar Kétsia Serra Introduction: Gastrointestinal granular cell tumor Araújo / Araújo, F. K. S. / Hospital Monsenhor Walfredo (GGCT) are uncommon. The most common site of GGCT Gurgel; Natália Marcelino Araújo / Araújo, N. M. / is the esophagus, but they make up less than 1% of Universidade Potiguar; Noele Gurgel Dávila / DÁvila, N. benign tumors of this organ. This neoplasm, described G. / Universidade Potiguar; Natassia Vianna Bocchese / in 1926 by Abrikossoff, can arise in different organs and Bocchese, N. V. originates from Schwann cells. Usually asymptomatic, they are discovered incidentally in endoscopies as Case Report: A 39-year-old man with long-standing grayish and / or yellowish submucosal nodules. Case gastrointestinal reflux disease has had epigastric pain Report: A 55-year-old female patient, who had been for 1 and a half months and a change in pain character. followed for 12 months for 0.5 mm Breslow cutaneous No dysphagia and weight loss. Abdominal ultrasound melanoma, with no poor prognostic factors, treated with (US) without alterations and upper digestive endoscopy margin extension, underwent endoscopy to investigate with raised distal esophageal lesion and polyp in the dyspeptic complaints. A yellowish 1.2 cm submucosal gastric body. On biopsy, hyperplastic polyp and 4.5 x nodular lesion 30cm from the upper dental arch was 3.6 mm distal esophageal granular cell tumor (GCT). observed. The biopsy showed an oesophageal GCT with Other normal exams. Slide revision requested for S100 staining positive on immunohistochemistry. The confirmation of histopathological diagnosis. Follow-up patient subsequently underwent mucosectomy of the with endoscopic US for subsequent tumor resection. lesion with free margins and diagnostic confirmation. Discussion: The tumor discovered by Abrikossoff She is currently in annual control after 3 years of in 1926 is a benign granulosa cell neoplasm, with 2 - diagnosis, with no evidence of local recurrence and in 4.3% being malignant, with metastases described. the treatment of gastroesophageal reflux disease. She Common in black men <45 years. Of uncertain origin, is also without evidence of melanoma related disease. attributed to different cells and tissues, it is found
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in the tongue, skin, breast, respiratory and digestive through the analysis of medical charts of patients tract, in a subepithelial location. Immunohistochemical with CG undergoing total or subtotal laparoscopic studies show association with peripheral nerve cells, gastrectomy for curative purposes by a single oncologic presenting S-100 protein, neuron specific enolase and surgery team. Patients were stratified according to age. myelin proteins. It affects the digestive tract (5 - 11%) - Results: Thirty-six patients were included in group I, one third in the esophagus, 65% in the distal third. Size and 63.9% were women. Also, 36 patients were included correlates with symptoms, whether dysphagia or pain. in group II, with 66.7% males. Regarding the ASA Intramural nodules are sessile protuberances such classification, 31% of the patients in group I presented as mild, solitary, gray-white lesions 1 to 4 cm, located ASA 1 classification, compared to 3.1% in group II. The in the muscularis proper, submucosa or infiltrating mean number of concomitant medications in group II pattern, covered by hyperplastic epithelium. There was statistically superior when compared to group I (5 ± is controversy regarding diagnosis and treatment. If 4.21 x 1.42 ± 3.08, p <0.001). Subtotal gastrectomy was benign, management is expected in asymptomatic the most performed procedure in both groups (69.4% patients and tumors <1 cm, with periodic endoscopic and 63.9% in groups I and II respectively) due to the high follow-up for 1 to 2 years. In symptomatic tumors> 1 cm, prevalence of distal tumors in both groups, 54.4% group fast growing, circumferential or with infiltrated margins, I and 52.9% group II. According to Laurens classification, resection is established. Due to the high morbidity group I presented a predominance of diffuse tumors of esophageal surgery, endoscopic polypectomy is (50%) and group II the intestinal type (61.8%). There indicated. Indications for endoscopic removal are size was no difference between the two groups regarding <2 cm and intact muscle layer. Relapse 5% of cases the number of resected lymph nodes and lymph nodes undergoing endoscopic resection. Concluding remarks: metastases, as well as the days of hospitalization, and The reported case and raised publications bring up the mortality. Conclusion: Laparoscopic gastrectomy is discussion of an unusual situation that is Abrikossoff‘s a safe procedure, with no differences in morbidity, esophageal tumor disease. It is noticed that patients mortality, and hospitalization time between young and outside the prevalent age group have progressive elderly patients. symptoms and large tumor, a rare event. Thus, they require polypectomy, with satisfactory and lasting Contato: Fernando Augusto de Vasconcellos Santos results in symptom relief and improved quality of life. [email protected]
Contato: Layae Barreto Costa [email protected] TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 87611
TEMÁRIO: TRATO GASTROINTESTINAL ALTO EVOLUTION OF ONCOLOGIC TREATMENT OF CÓDIGO: 88093 ESOPHAGEAL CANCER: INCREASE IN OVERALL SURVIVAL IN 335 CASES OPERATED OVER 20 EVALUATION OF LAPAROSCOPIC RADICAL YEARS IN A SINGLE INSTITUTION GASTRECTOMY IN YOUNG AND ELDERLY PATIENTS WITH GASTRIC CARCINOMA Autores: Luiza Mesquita Barbosa / Barbosa, L. M. / Hospital Erasto Gaertner ; Ewerson Luiz Cavalcanti Silva Autores: Fernando Augusto de Vasconcellos Santos / / Silva, E.L.C. / Hospital Erasto Gaertner; Danilo Saavedra Santos, F.A.V. / Faculdade Ciências Médicas de Minas Bussyguin / Bussyguin, D.S. / Hospital Erasto Gaertner; Gerais; Vinicius Ribeiro Leduc / Leduc, V.R. / Faculdade Vitoria Diana Mateus Almeida Gonçalves / Gonçalves, Ciências Médicas de Minas Gerais; Paula Segato Vaz de V.D.M.A. / Hospital Erasto Gaertner; Vinicius Basso Oliveira / Oliveira, P.S.V. / Oncad; Gabrielle S P Lomba / Preti / Preti, V.B. / Hospital Erasto Gaertner; Gerardo Lomba, G.S.P. / Faculdade Ciências Médicas de Minas Cristino Gavarrete Valladares / Valladares, G.C.G. / Gerais; Gabriela Dias de Figueiredo / Figueiredo, G.D. Hospital Erasto Gaertner; Raphaella Ferreira / Ferreira, / Faculdade Ciências Médicas de Minas Gerais; Joana P R. / Hospital Erasto Gaertner; Phillipe Abreu / Abreu, Kalil / Kalil, J.P. / Oncad; Alberto Julius Alves Wainstein / P. / Hospital Erasto Gaertner; Flavio Daniel Saavedra Wainstein, A.J.A. / Faculdade Ciências Médicas de Minas Tomasich / Tomasich, F.D.S. / Hospital Erasto Gaertner. Gerais; Ana Paula Drummond-lage / Drummond-Lage, A.P. / Faculdade Ciências Médicas de Minas Gerais. Summary Objective: To present the surgical and oncological results of patients with esophageal cancer Background: Considering the higher life expectancy, who underwent surgery in the same institution at three and consequently increasing in the elderly population, different historical moments, and to compare their a higher incidence of gastric cancer (GC) is expected outcomes according to the treatment strategy used. in this population in the coming decades. Métodos: Method: Comparative analysis of the surgical results Foi realizado um estudo retrospectivo, transversal, obtained by the Oncological Surgery Service of Hospital através da análise de prontuários médicos de pacientes Erasto Gaertner, in the treatment of esophageal com CG, submetidos à gastrectomia total ou subtotal cancer, in three different chronological moments. The laparoscópica com finalidade curativa, por uma única procedure was always performed by the same team Aim: To compare the results of laparoscopic GC surgical in the three moments. The 3 analyses were divided treatment between individuals aged <65 years (group I) as follows: It was 1 (1997), It was 2 (2003), It was 3 and ≥ 65 years (group II), according to clinical, surgical, (2015). The data were analyzed with the programs and histopathological characteristics. Methods: A SPSS 23.0 and STATA15, being p<0.05 considered cross-sectional retrospective study was performed statistically significant.Results: 335 patients underwent
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esophagogastricrectomy during the study period. lymphadenectomy in the DII and in only 8 cases of DI Neoadjuvance was significantly higher in Era 3, where lymphadenectomy. Body and antrum tumors were it reached 55.4% of patients. We observed a histological the most common (88.7%). The most common surgery change in the diagnosis over time, with a significant was subtotal gastrectomy (62.9%), followed by total increase in adenocarcinoma. The surgical variables gastrectomy (34.7%) and only three degastrectomies. did not show statistical differences in the 3 historical The standard reconstruction performed at our moments. Morbidity and mortality rates were higher institution is Roux-en-Y and was performed in 98.4% of in Era 3. The main complications were pulmonary cases. Blood transfusion was required in less than 5% and anastomotic fistulas. The overall survival in 5 of cases. Postoperative complications were present in years was increasing over time, reaching 59.7% in Era 34.7% of cases, and a large majority (81.5%) were not 3. Conclusions: The evolutionary study of the cases required for invasive invasions (endoscopic, surgical or demonstrates the continuous improvement of the radiological). Conclusion: These findings suggested that results of the service in the treatment of esophageal minimally invasive surgery for gastric cancer is feasible, cancer. Better preoperative nutritional therapy clinically impacting recent results of perioperative associated with neoadjuvant treatment increased the morbidity and mortality compared to a conventional overall survival of patients. open approach without cancer impairment.
Contato: Luiza Mesquita Barbosa Contato: Gustavo Ferreira Araruna [email protected] [email protected]
TEMÁRIO: TRATO GASTROINTESTINAL ALTO TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 88343 CÓDIGO: 87593
FIVE YEARS OF MINIMALLY INVASIVE GASTRIC CANCER IN A JEHOVAH WITNESS: A GASTRECTOMY IN A SINGLE INSTITUTION CASE REPORT - FEASIBILITY AND IMPACT ON MORBIDITY Autores: Gustavo Torres Lopes Santos / Santos,G.T.L. AND MORTALITY COMPARED TO A / Liga contra o Cancer - RN; George Alexandre Lira / CONVENCIONAL OPEN APPROACH Lira,G.A. / Liga Contra o Cancer - RN; Gabriela Benneti de Grande Santos / Santos, G.B.G. / UNP - RN; Francyjane Autores: Gustavo Ferreira Araruna / Araruna, G.F. / AC Emanuela Ferreira de Mesquita Silva / Silva,F.E.F.M / CAMARGO; Wilson Luiz da Costa Jr / Costa Jr, W.L. / AC UNP - RN; Marjorie Ravena de Oliveira Pereira Borges CAMARGO; Heber Salvador de Castro Ribeiro / Ribeiro, / Borges,M.R.O.P / UNP - RN; Lara Valeska de Medeiros H.S.C. / AC CAMARGO; Alessandro Landskron Diniz / Rocha / Rocha,L.V.M / UFRN; Barbara Paulo Cavalcante Diniz, A.L. / AC CAMARGO; Silvio Melo Torres / Torres, / Cavalcante,B.P. / UNP - RN. S.M. / AC CAMARGO; Igor Correia de Farias / De Farias, I.C. / AC CAMARGO; André Luis de Godoy / Godoy, Case Report: E.L., female, 38 years old, asymptomatic A.L. / AC CAMARGO; Felipe Jose Fernandez Coimbra / Jehovah‘s Witness, with EDA: 2cm gastric fundus Coimbra, F.J.F. / AC CAMARGO. posterior wall ulcer and 1.5cm small curvature nodule. Biopsy: Signet ring like clusters of cells Introduction: Gastric cancer is one of the most with undefined changes between reactivity and common cancers today. In Brazil, it is the third most malignancy. Immunohistochemistry: Signet ring cell common type among men and the fifth among women. adenocarcinoma, CLUSTER 5. Patient reported weight Surgery is the main form of curative treatment for loss due to diet, denied dysphagia, comorbidities, gastric cancer patients. It is indicated in all cases of smoking, alcoholism. Family history of mother and patients who are candidates for curative treatment and aunt with breast cancer. On examination: flaccid, not candidates for endoscopic resection, and an extent painless abdomen with no visceromegaly or palpable of resection is conditioned by analysis of an adequate lymph nodes. It was clarified as to the possibility of proximal margin. An abdominal gastrectomy for open blood transfusion. Chest CT: uncalcified pulmonary adenocarcinoma has been performed since the 1900s micronodule in the right lower lobe; Abdominal CT: Small in Brazil. Laparoscopic gastrectomy was first recorded in ulcerated lesion in the gastric body. During surgery, no Japan in 1994. Since then, a minimally invasive surgical signs of peritoneal disease, stomach with small ulcer in experience has increased. Objective: To evaluate posterior gastric wall. Small lymph nodes in celiac trunk. the results of laparoscopic and robotic gastrectomy Abdominal esophagogastrectomy, retroperitoneal IBD in patients with 5-year gastric adenocarcinoma in a lymphadenectomy, omentectomy, proximal jejunum single institution. MATERIALS AND Methods: The study enterectomy, Roux-en-Y reconstruction with 25mm included patients with pathological diagnosis of clinical circular stapler anastomosis, nasoenteral tube passage adenocarcinoma of videolaparoscopic or robotic after anastomoses. No blood transfusion was required. gastrectomy between 2013 and 2018. Immediate results Evolved well postoperatively, Anatomopathological: were analyzed (overall morbidity, severe morbidity, gastric adenocarcinoma pT4aN2M0 - IIIA, KPS mortality, lymph node number). dissected and length of 100%. referred for chemotherapy with MacDonald‘s stay) and late (overall survival and disease-free survival) scheme - 5-fluoracil plus Leucovorin - progresses of individuals with minimally invasive gastrectomies. asymptomatically. Discussion: Gastric cancer is the Results: 124 gastrectomies were performed, with a third most common type among men and the fifth mean age of 59 years. The average number of dissected among women in Brazil. Adenocarcinoma accounts lymph nodes was 31, and most cases (93.5%) underwent
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for about 95% of cases, is common in men between embryonic and extra-embryonic tissues. In the fourth 60 and 70 years. By Lauren‘s classification, it can be embryonic week germ cells migrate from the yolk sac subdivided into diffuse and intestinal. The diffuse toward the posterior wall of the primitive intestine to type presents macroscopically ulcerated or infiltrative the genital crest. If, for reasons not yet known, cells and microscopically as poorly differentiated. Its signet do not complete migration, usually near the midline, ring cells produce extensive amounts of mucin and they may lead to tumors in extragonadal areas. infiltrative growth pattern. It mainly affects the cardia Final comments: These tumors exhibit a complex and is more frequent in young people. The treatment histological picture. This case was initially diagnosed as is essentially surgical, taking into consideration the gastric adenocarcinoma. Careful immunohistochemical stage and location of the tumor, being more indicated analysis is vital for its diagnosis. in the diffuse type, the total gastrectomy. Final considerations:Preoperative preparation is critical in Contato: Gabriel da Rocha Bonatto the handling of Jehovah‘s Witness patients. All team [email protected] planning (clinician, surgeon, anesthesiologist and intensivist) allows surgical procedures with significant blood loss without transfusion. TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 87538 Contato: Gustavo Torres Lopes Santos [email protected] GASTRIC INFLAMMATORY MYFIBROBLASTIC TUMOR SIMULATING OBSTRUCTIVE GIST -
TEMÁRIO: TRATO GASTROINTESTINAL ALTO CASE REPORT CÓDIGO: 87298 Autores: Daniel Eiji Ogino / Ogino, DE / Hospital Universitário joão de Barros Barreto; João Felipe Leite GASTRIC ENDODERMIC TUMOR Acioli / Acioli, JFL / Hospital Universitário joão de Barros Barreto; Marielle de Nazaré Gonçalves de Lima e Silva Autores: Gabriel da Rocha Bonatto / Bonatto, G. R. / Silva, MNGL / Hospital Universitário joão de Barros / Hospital de amor de barretos; Diego Burgardt / Barreto; Andressa Cristina Teixeira Fontel / Fontel, ACT Burgardt, D. / Hospital de amor de barretos; Lidio / Hospital Universitário joão de Barros Barreto; Rodrigo Carvalho da Silva Lima / Carvalho, L. S. L. / Hospital Ferreira da Silva / Da Silva, RF / Hospital Universitário de amor de barretos; Max Wellington Satiro Justino / joão de Barros Barreto; Zacarias Farias da Silva / Da Justino, M. W. S. / Hospital de amor de barretos; Paulo Silva, ZF / Hospital Universitário joão de Barros Barreto; Victor Fortes Sampaio / Fortes, P. V. S. / Hospital de amor Geraldo Ishak / Ishak, G / Hospital Universitário joão de de barretos; Durval Renato Wohnrath / Wohnrath, D. Barros Barreto; Pedro Antônio Mufarrej Hage / Hage, R. / Hospital de amor de barretos; ênio David Mente / PAM / Hospital Universitário joão de Barros Barreto. Mente, E. D. / Hospital de amor de barretos; Fernando Ernesto Cruz Felippe / Felippe, F. E. C. / Hospital de J.A.S.P, 15 years old, with dyspeptic symptoms, amor de barretos; Marcos Aurélio Sanctis / Sanctis, M. postprandial vomiting and severe weight loss. A. / Hospital de amor de barretos. Performed several upper digestive endoscopy (UDE) with inconclusive results. At the HUJBB surgery service, Presentation: Male patient, 41 years old, BMI: 22, PS: the patient underwent an UDE, which revealed a 1, healthy. Four months ago onset of epigastric pain, bulging, bulky, ulcerated lesion covering the distal vomiting after feeding, melena episodes and weight gastric body / antrum, with a significant decrease in loss of 10kg. Physical examination: BEG, hypocolored 1 lumen. On echoendoscopy, a large and obstructive + / 4 +. Abdomen: Flaccid, without palpable masses. No subepithelial lesion was described in the distal gastric lymph node enlargement. Laboratory tests (08/28/19): body with involvement of all layers and invasion of an Hb: 6.1g / dL Ht: 21.5%. EDA (08/29/18): Infiltrating adjacent structure suggestive of GIST. Gastric biopsy ulcerative lesion extending through the small curvature revealed mucosa with foci of infiltration by atypical and part of the anterior and posterior walls of the distal cells associated with ulceration. Complementation antrum. Type Bormann III. AP: Lauren‘s moderately with immunohistochemistry (IHC) has been suggested. differentiated, ulcerated, and infiltrative intestinal- However, due to the obstructive condition, the type adenocarcinoma. CT (08/30/18): Irregular parietal patient underwent subtotal gastrectomy + Roux- thickening in the small curvature, body and gastric en-Y gastroenteroanastomosis, whose findings were: antrum, poorly defined limits. Perilesional fat density, obstructive submucosal tumor, bulging of the gastric lymph node enlargement in this topography, measuring mucosa, without invasion of it in the distal and antrum, up to 3.0 x 2.5cm, some with foci of calcification inside. with serous leakage. without involvement of adjacent Due to bleeding, on 09/21/18 total gastrectomy + D2 organs. Absence of lesions suggestive of metastasis, + Roux-en-Y lymphadenectomy was performed. AP lymph node enlargement or ascites. Histopathology Outcome: Gastric endodermal sinus tumor of the concluded ulcerated fusocellular neoplasia, rich glandular pattern. Size: 6.7cm of den. IAL +, IPN -. Free in plasma cells and lymphocytes, with lymphoid margins. Lymph nodes 24 + / 55. Laboratory tests aggregates and areas of calcification with margins and (11/29/18): DHL: 533U / L, α-fetus Protein: 4.13ng / lymph nodes free of neoplasia. IHC revealed positivity ml, β-HCG: 2.39mIU / ml, TGO: 177U / L, TGP: 325U / for smooth muscle actin in myofibroblastic pattern. L, GGT: 367U / L, FA: 150U / L. Adjuvant chemotherapy Thus, the set of findings in the anatomical-clinical not indicated due to liver enzyme changes Discussion: context was consistent with a diagnosis of inflammatory Presentation as a primary stomach tumor is extremely myofibroblastic tumor. Remains on outpatient follow- rare. Germ cells are pluripotent and give rise to
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up. DISCUSSION Inflammatory myofibroblastic gastrostomia, já descritas na literatura. METODO: tumors are benign mesenchymal tumors arising from Confecção de gastrostomia cirúrgica aberta non-neoplastic proliferation of myofibroblastic and minimamente invasiva diante da impossibilidade de inflammatory cells (lymphocytes and eosinophils). These realização de procedimento endoscópico. Técnica: are rare lesions and the most common site is the lungs, incisão transversa em região epigástrica a esquerda da may affect the bladder, liver, large intestine, spleen and linha média, abertura transversa da bainha anterior da heart. Its presence in the stomach is extremely rare, aponeurose do músculo reto abdominal, divulsão da there are few cases described in the literature and most musculatura e abertura longitudinal da bainha posterior are incidental or obstructive findings. In this region, do mesmo. Tração gástrica e confecção de bolsa they can be confused with GIST, being differentiated conforme descrito por Stamm, com inserção de sonda by IHC. Not much is known about the prognosis. alimentar por contraincisão transretal. Aproximação da Treatment consists of total exeresis due to the risk of musculatura e síntese da aponeurose anterior do reto recurrence, growth or metastasis. CONCLUSION Due to abdominal. RESULTADOS: Confecção de gastrostomia the rarity of the tumor and its infrequent location, it is aberta minimamente invasiva, modificada da técnica easily confused with GISTs, requiring the use of IHC in de Stamm, sem abertura de linha aponeurótica the differential diagnosis. Caution should be exercised média e acesso transretal, com menor potencial in follow-up due to its unpredictability. de complicações em relação a parede abdominal e desabamento de gastrostomia. DISCUSSAO: Diante Contato: Daniel Eiji Ogino das complicações catastróficas descritas na literatura [email protected] associadas a abordagem mediana laparatômica para confecção de gastrostomia, a incisão transretal mínima se apresenta como um técnica com menor potencial de TEMÁRIO: TRATO GASTROINTESTINAL ALTO complicações e, portanto, promissora. CÓDIGO: 88373 Contato: Thais da Costa Pinto Rodrigues GASTROSTOMIA ABERTA MINIMAMENTE [email protected] INVASIVA: TÉCNICA CIRÚRGICA
Autores: Thais Thais da Costa Pinto Rodrigues / TEMÁRIO: TRATO GASTROINTESTINAL ALTO Rodrigues, T.C.P / IMIP; Kelwin Madson da Silva / Silva, CÓDIGO: 88286 K.M / IMIP; Cristiano de Souza Leão / Leão, C.S / IMIP; Angelo Teles de Carvalho Filho / Filho, A.T.C / IMIP; HEREDITARY DIFFUSE GASTRIC CANCER Omar Jacobina de Figueiredo / Figueiredo, O.J / IMIP; SYNDROME - CDH1 MUTATION: GENETIC Felipe Augusto Chaves Machado / Machado, F.A.C / IMIP; Victor Lira de Oliveira / Oliveira, V.L / IMIP; Michele ANALYSIS OF A BRAZILIAN FAMILY Chalegre Viana / Viana, M.C / IMIP; Marcelo Henrique Autores: Thiago Pereira Diniz / Diniz, T.P. / AC Camargo Ferreira Fernandes / Fernandes, M.H.F / IMIP; Antonio Cancer Center. ; Felipe J F Coimbra / / AC Camargo Cavalcanti de Albuquerque Martins / Martins, A.C.A / Cancer Center.; Caio Nasser Mancini / / AC Camargo IMIP. Cancer Center.; Vinicius Vertematti de Castro / / AC Camargo Cancer Center; Maurício Muniz Magalhães / / INTRODUÇAO: A primeira gastrostomia cirúrgica foi AC Camargo Cancer Center; Murilo Silva Andrade / / AC realizada (inicialmente) em animais em 1839 por Camargo Cancer Center; Anthony Lee de Souza Worley Charles Sédillot e em humanos somente em 1876 / / AC Camargo Cancer Center; Carlos Sabas Vieira / / por Verneoil. Ao longo dos anos, várias modificações Universidade Federal do Piauí; Felipe D´almeida Costa foram realizadas e novas técnicas foram incorporadas / / AC Camargo Cancer Center; Cicero Diego Soares dos ao arsenal terapêutico, incluindo a abordagem não Santos / / AC Camargo Cancer Center. cirúrgica através da realização da gastrostomia endoscópica. Nos pacientes não elegíveis para Case Report: Male, 35 years old, sought referral esta abordagem, a intervenção cirúrgica é a opção service due to family history of gastric cancer (GC). terapêutica, laparoscópica ou aberta. Dentre as técnicas His sister died at 25 years old from GC and brother abertas, destaca-se a técnica de Stamm, idealizada em at 21y-old underwent prophylactic total gastrectomy 1894 e uma das mais utilizadas até hoje. Ela consiste (with proven CDH1 mutation). Then, upper digestive no acesso laparotômico mediano supra umbilical e endoscopy (EDA) and geneticist evaluation were sutura em bolsa para fixacão da sonda gástrica. Nas requested. CDH1 mutation screening was positive. At complicações descritas na literatura, evisceração, the patient‘s wish, we opted for active follow-up, with eventração e desabamento de gastrostomia são EDA and bi-annual biopsies. After 5 years of follow-up, apresentas de maneira não desprezível, principalmente endoscopic examination revealed a linear erosion in se considerarmos o grau de desnutrição dos pacientes the gastric antrum, isolated, measuring 0.5cm, whose submetidos a tal abordagem), sendo assim eventos anatomopathological report was diffuse Lauren invasive catastróficos. Neste contexto, a modificação da técnica adenocarcinoma with signet ring cells. The patient de Stamm para uma abordagem aberta minimamente underwent total gastrectomy with lymphadenectomy invasiva foi idealizada. Objetivo: Descrever a and in the final pathology there was no residual disease adaptação da técnica de gastrostomia à Stamm para in the surgical specimen. He is currently alive without uma abordagem cirúrgica aberta minimamente disease in follow-up. The mutation was inherited from invasiva, levando em consideração complicações your father, that remains alive and without evidence of como evisceração, eventração e desabamento de disease. Discussion: Hereditary diffuse gastric cancer
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accounts (HDGC) for only 1 3% of cases of gastric with gastroduodenal artery. Ca19-9 high. Performed cancer. It is an autosomal dominant syndrome due to cpre with prosthesis passage for vvbb drainage and germline mutations in the CDH1 gene, that encoding ecoeda that demonstrated heterogenic injury in head a glycoprotein with cell adhesion function, E-cadherin. / uncinated pancreatic process. Fulfilled paaf without This syndrome has a high genetic penetrance and all indications of badness after 2 months of evolution patients should be followed by a multidisciplinary you entered our pet-ct service that was evidenced team, including family genetic counseling. Mutation already described with suv of 5.8 And diffused suv screening is performed only on at-risk patients using lymphonodomegalies between 2.1 And 4.1. Image- well-established criteria. There is currently no proven guided pancreatic injury and axilar lymphonode bipsy, effective surveillance method for HDGC detection, which revealed inflammatory inflammatory pancreatic therefore prophylactic gastrectomy remains the only process with igg4-related disease complementation; option to eliminate inherited HDGC risk, standard lymphonode, negative for malignity. The case was procedure in CDH1 gene mutation carriers. Conclusio: discussed in multidisciplinary meeting and proposed This case report represents a typical case of diffuse treatment with corticotherapy and clinical review. hereditary gastric cancer with CDH1 gene mutation Patient presented best progressive clinic and after 3 present, with natural history of the disease and genetic months c19-9 standardization. Picture examinations penetrance in accordance with the literature. However, with significant decrease in pancreatic injury, being there is a disagreement between screening examination removed bilary prosthesis. Patient keeps ambulatory and surgical specimen analysis. Normally, endoscopic follow-up with good evolution and return to habit examination and biopsy are normal and after surgery activities. Sclerosing pancreatitis is a rare pathology of show disease in the surgical specimen. In this case autoimmune ethology, which differential diagnosis with there was the opposite. pancreatic neoplasia is complex, because may meimize pancreatic adenocarcinoma mainly when developed Contato: Thiago Pereira Diniz in the pancreas head. This case report is intended [email protected] to alert for differential diagnosis with pancrea head adenocarcinoma, with the event of avoiding surgical interventions with high morbimortality when compared TEMÁRIO: TRATO GASTROINTESTINAL ALTO with institute core treatment. CÓDIGO: 87882 Contato: Cicero Diego Soares dos Santos IGG4 RELATED SCLEROSING PANCREATITIS AS [email protected] DIFFERENTIAL DIAGNOSIS OF PANCREATIC
HEAD ADENOCARCINOMA: CASE REPORT TEMÁRIO: TRATO GASTROINTESTINAL ALTO Autores: Cicero Diego Soares dos Santos / SANTOS, CÓDIGO: 85107 C.D.S / HOSPITAL AC CAMARGO; Andre Luis de Godoy / GODOY, A.L. / HOSPITAL AC CAMARGO; Silvio Melo IMUNONUTRIÇÃO EM CIRURGIAS Torres / TORRES, S.M. / HOSPITAL AC CAMARGO; ONCOLÓGICAS DO TRATO GASTRINTESTINAL Guillermo Manozzo Trevisol / TREVISOL, G.M. / ALTO E HEPATOBILIOPANCREÁTICAS HOSPITAL AC CAMARGO; Thiago Pereira Diniz / DINIZ, T.P. / HOSPITAL AC CAMARGO; Andrey Richard Lisboa Autores: Thais Manfrinato Miola / Miola, TM / Martins / MARTINS, A.R.L. / HOSPITAL AC CAMARGO; ACCamargo Cancer Center; Leticia Nascimento Rivaldo Serrano de Andrade Neto / NETO, R.S.A. / Carniatto / Carniato, LN / ACCamargo Cancer Center; HOSPITAL AC CAMARGO; Igor Correia de Farias / FARIAS, Fabiane Michele dos Santos / Santos, FM / ACCamargo I.C. / HOSPITAL AC CAMARGO; Wilson Luiz da Costa Cancer Center. Junior / JUNIOR, W.L.C / HOSPITAL AC CAMARGO; Felipe Jose Fernandez Coimbra / COIMBRA, F.J.F. / HOSPITAL Introdução: o uso de fórmulas nutricionais contendo AC CAMARGO. nutrientes imunomoduladores no pré-operatório modula a resposta inflamatória e melhora a síntese This is a clinical case of a 71-year-old patient with protéica, reduzindo complicações pós-operatórias a hypoxia, inappetence and weight loss of 5 kg e tempo de internação. Objetivo: analisar o uso de (corresponding to 8% of the weight), which evolved fórmulas imunomoduladoras no pré-operatório de with obstructive jaundice, pruritus, collecal fever cirurgias oncológicas do trato gastrintestinal alto e and columbia. Examination showed ictericia 2 + / 4, hepatobiliopancreáticas. Materiais e Métodos: o estudo give pain abdominal palpation in epigaster and right foi do tipo retrospectivo, observacional, de caso- hypocondy. Background of umbilical herniorraphy and controle. Foram avaliados 96 pacientes que realizaram bilateral inguinal hernioplasty. Family history of father a suplementação com nutrientes imunomoduladores lung cancer and pattern grandmother gastric cancer. antes da cirurgia e comparados com 50 pacientes She conducted us abdome that showed evidence of que não realizaram a imunonutrição. As variáveis pancreatic head mass and bile duct dilatation (vvbb). avaliadas foram o estado nutricional, complicações no Abdome tomography has been demonstrated beyond pós-operatório e tempo de internação. Resultados: a dilatation, abstract stolenosis stenosis in its intra- amostra foi composta por 55,5% de indivíduos do sexo pancreatic portion. Pancreatic ducus dilation to the masculino e 44,5% do sexo feminino, com idade média level of the cephalic portion with open stenosis. 4.5Cm de 61,8±12,4 anos. O estado nutricional mais prevalente hypovascular injury in uncinced process, with contact foi a eutrofia (33,6%), enquanto que a desnutrição over 180 degrees with top mesental vein, and contact estava presente em 17,1% da amostra. A complicação
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no pós-operatório foi presente em 45,8% dos pacientes insulinomas can be cured with surgery. The choice of que consumiram o suplemento e em 40% daqueles surgical procedure depends on the size and location que não consumiram, não apresentando diferenças of the lesion. Tumor enucleation is the procedure of significativas (p=0,618), sendo a fístula a complicação choice, especially in the case of a small, solitary nodule mais frequente (9,6%). A média de dias de internação that is not invading the pancreatic or biliary ducts. para quem consumiu o suplemento foi de 16,8 dias Pancreatic resection is indicated for invasive lesions or e para o grupo que não consumiu foi de 18,9 dias, in nearby areas with pancreatic duct or large vessels, sem diferenças significativas (p=0,377). Conclusão: or suspected malignancy. Clinical management of no presente estudo a imunonutrição não mostrou insulinoma is reserved for treating and preventing resultados significativos. Porém o estudo apresentou hypoglycemia, for unresectable or metastatic tumors, algumas limitações, como não ter comparado a via unsuccessful operation with persistent symptoms, de acesso da cirurgia e outras condutas que auxiliam inoperable patients, and patients awaiting or refusing na redução das complicações e tempo de internação, surgery. como abreviação de jejum pré-operatório e mobilização precoce. Contato: Bruno Pacheco [email protected] Contato: Thais Manfrinato Miola [email protected] TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 87105 TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 87522 JEJUNAL INTERPOSITION FOR ESOPHAGEAL REPLACEMENT AFTER ESOPHAGECTOMY - A INSULINOMA - CASE REPORT AND REVIEW OF REMINDER OF AN ALTERNATIVE CONDUIT LITERATURE Autores: Marcos Duarte Siosaki / Siosaki, M. D. / Hospital Autores: Bruno Pacheco / Pacheco, B. / Fundação Estadual Bauru; Angelo Scaldini Salomão / Salomão, A. Cristiano Varela ; Edson Augusto Ribeiro / Ribeiro E. / S. / Hospital Estadual Bauru; Aloma da Fonseca Sandrin Fundação Cristiano Varela; Leandro Siqueira Correa / / Sandrin, A. F. / Hospital Estadual Bauru; Paulo Ernesto Correa L. / Fundação Cristiano Varella; José Luiz Bravin / Vidoto Talarico / Talarico, P. E. V. / Hospital Estadual Bravin J.L. / Fundação Cristiano Varella. Bauru.
Female, 43 years old, rural worker with hypoglycemia Case Presentation: A 65-year-old male, submitted triggered by varying periods of fasting, including to subtotal gastrectomy with BII reconstruction in sweating, tachycardia, tremors and reproduction of 1990 by gastric ulcer, with an initial diagnosis of SCC lowering of consciousness, associated with weight loss, locally advanced in the middle esophagus infiltrating initiated in 2016. Patient experiences improvement carina, underwent definitive chemoradiotherapy in symptoms when “eating something”. On physical until October 2017. Recurrence of disease was examination, the patient has a good performance one year later. He underwent videolaparoscopic status (KPS DE 80%), body mass index 25.28 KG / M2. esophagectomy with jejunal interposition without Laboratory tests of the patient showed glucose level supercharging due to adhesions compromising colon elevated and insulin level within the normal range. pull-up for reconstruction in November 2018. During Prolonged fasting test was started and patient presented the postoperative course presented fistula of the sweating, weakness, slurred speech and capillary blood esophago-jejunal anastomosis drained to the cervical glucose of 46 MG / DL (70 A 100 MG / DL) with 4 hours region. Discharge from hospital was in the 14th of fasting. MRI of the abdomen showed two contrast- postoperative day. Discussion: Re-establishment of enhancing pancreatic tumors with similar features, one gastrointestinal continuity is a critical determinant of in the head and one in the body, measuring respectively quality of life following esophagectomy. The stomach 1.9 and 2.1 cm, respectively, with no evidence of distant has gained favor for its length, reliable vascular supply disease or intraabdominal lymph node enlargement. and need for only a single anastomosis. However, there Exploratory laparotomy identified the two lesions, are times when the stomach is unavailable for use as a and duodenopancreatectomy was performed, conduit. Although Roux was the first surgeon to replace pancreatogastric reconstruction by telescoping of the esophagus with jejunum in 1907, Longmire was the pâncreas and biliodigestive reconstruction with Roux-Y. first to describe a long-segment jejunal interposition Patient was discharged on the 8 th postoperative with microvascular augmentation, also known as day. Insulinoma is the most common endocrine supercharging, to enhance the vascular supply of the tumor, with an incidence of 1-4 people per million conduit and to decrease risks of ischemia. It has a and can occur at any age and have preference for reliable blood supply, which is clearly enhanced at women. It is the most common cause of endogenous the level of the anastomosis with the supercharged hyperinsulinism hypoglycemia. Histologically, they technique. There is also significant amount of are epithelial neoplasms associated with strong and redundant jejunum so the patient will not be harmed diffuse expressions of neuroendocrine markers, such by loss of that length of jejunum, and the jejunum as synaptophysine and chromogranin. In most cases, it tends to lack intrinsic pathology. The jejunum also is benign, solitary, sporadic and less than 2 cm. About has intrinsic peristalsis, which has potential benefits 10% of the time occurs as part of the MEN 1 (Multiple for quality of life. Disadvantages of the supercharged Endocrine Neoplasia) syndrome. Most patients with jejunal conduit include the need for a microvascular
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anastomosis (if supercharged), jejunal conduits may findings come after local complication, with a 5 year not be long enough to reach the hypopharynx. Fatty survival of 25%. In this case, the diagnosis was made mesentery may also inhibit the surgeons ability to late, and 2 endoscopies were previously performed pull up the conduit. Final comments: The jejunum that did not show intestinal disease. The treatment is uniquely suitable for esophageal reconstruction is surgical resection with minimum safety margins of because it is relatively abundant, does not require a 5 cm associated with local lymphadenectomy. Final formal preparation, is typically free of disease, has considerations:Malignant small bowel tumors are rare. similar luminal size compared to the esophagus, has They usually have a poor prognosis due to unspecific intrinsic peristalsis, and may not undergo senescent symptoms and difficult diagnosis. The recommended lengthening to the extent that colon does. The paper treatment is surgical resection. Adjuvant therapies may tries to present a reminder of an alternative feasible be given, but the results are unsatisfactory. conduit after esophagectomy that can be done also without supercharging. Contato: Leonardo Mundim Andrade Porto [email protected] Contato: Paulo Ernesto Vidoto Talarico [email protected] TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 86961 TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 87974 MANAGEMENT OF TYPE 1 GASTRIC NEURO- ENDOCRINE TUMOR WITH SOMATOSTATIN JEJUNUM ADENOCARCINOMA ANALOGUES Autores: Leonardo Mundim Andrade Porto / Porto, Autores: Ana Beatriz Tabosa Negrão Xavier / Xavier, L. M. A / UniAtenas; Bruna Pereira Silva / Silva, B. P. A.B.T.N / Instituto de Assistência Médica ao Servidor / UniAtenas; Ana Laura Mundim Andrade Porto / Público Estadual de São Paulo - IAMSPE; Ana Beatriz Porto, A. L. M. A. / UniAtenas; Jassiara Soares da Silva Lima Resende / Resende, A.B.L / Instituto de Assistência / Silva, J. S. / UniAtenas; Josue da Silva Brito / Brito, J. Médica ao Servidor Público Estadual de São Paulo S. / UniAtenas; Fernando Lucas Queiroz Abreu / Abreu, - IAMSPE; Débora Vilins / Vilins, D. / Instituto de F. L. Q. / UniAtenas; Isadora Andrade Porto Campos Assistência Médica ao Servidor Público Estadual de São / Campos, I. A. P. / UniAtenas; Laura Cesar Antunes / Paulo - IAMSPE; Ytauan Barros Calheiros / Calheiros, Y.B Antunes, L. C. / UniAtenas. / Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo - IAMSPE. Case Report: S.A., 47 years old, female, from Paracatu MG, presenting abdominal pain, significant unweighted CASE 1: 50-year-old woman complaining of bloating weight loss, vomiting, asthenia and hyporexia for 4 and heartburn for 6 years. Endoscopy showed atrophic months. Having evolution with recurrent and incoercible pangastritis and multiple elevated gastric lesions from vomiting. She sought medical help several times, and 1 to 7mm. The biopsy revealed type 1 GNET (1% Ki-67), hypotheses of nonspecific gastropathies, vomiting positive chromogranin and synaptophysin. Initial serum of psychosomatic origin and anxiety disorders were gastrin = 617 pg / ml, without distance disease. Due to raised. The patient progressed to acute renal failure the large number of lesions, endoscopic treatment was due to dehydration and was referred to nephrology not possible. Was instututed treatment with long-term when a triple contrast CT scan was performed, which octreotide (20mg / month) as an intermediate approach revealed solid expansive neoplastic formation affecting between expected conduct and antrectomy. Serum the proximal jejunum at 70 mm from the Treitz angle, gastrin normalized (85 pg / ml) in 3 months, and in 6 measuring 41 mm. , promoting luminal stenosis months endoscopy no longer identified lesions. CASE 2: and fluid distention of the duodenum and stomach 54-year-old woman complaining of burning epigastric and absence of lymph node enlargement or lesions pain for 5 years. Endoscopy showed enanthematous indicative of secondary implants. The patient was gastritis and multiple polypoid lesions in the gastric referred to the HMP General Surgery team. She had body with approximately 3 mm. Biopsy revealed type adequate vital signs and painful abdomen on palpation 1 neuroendocrine tumors. Initial gastrin = 538 pg / ml. of the periumbilical region, without signs of peritoneal We introduced treatment with long term medication irritation. Laboratory tests showed hemoglobin 11.9 g / as an intermediate approach between expectating dL, leukocytes 8,100 mm³, creatinina 8.9 mg / dL, urea conduct and antrectomy, 20mg / month, and observed 219.0 mg / dL, K + 3.9 mEq / L and Na + 120.0 mEq / L. On normalization of serum gastrin (73.5 pg / ml) after 3 the 8th day of hospitalization, exploratory laparotomy months. Discussion: Gastric neuroendocrine tumors was performed, resection of the affected segment are classified into three types of etiopathogenesis with wide safety margins and lymphadenectomy with and distinct configurations. Type 1 lesions comprise primary end-to-end enteroanastomosis, and no other 80% of the cases, associated with atrophic chronic lesions were identified. Pathological analysis showed gastritis and consequently the elevation of serum proximal jejunum adenocarcinoma affecting the entire gastrin (peptide that stimulates as enterochromaffin intestinal wall, extending into the subserosa and cells). Typical cases are asymptomatic, presenting infiltrating the peri-intestinal fat and a lymph node with nonspecific dyspepsia. The diagnosis is by endoscopy, neoplastic infiltration. Discussion: Due to nonspecific finding medium polyps with yellowish borders, smaller presentation of adenocarcinoma,it is commonly than 1 cm, frequently multiple, localized in fundus or diagnosed late, implying that only half of the patients gastric body. Immunohistochemistry is positive for may undergo curative surgical resection. Most of the
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chromogranin A, and Ki-67 is usually lower than 2% of inflammation, bleeding and fibrosis. The clinic is (indolent disease behavior). The conduct can be only nonspecific and the indolent forms of the disease expectant. The endoscopic or antrectomy surgical do not require specific treatment, but in the most approach has frequent recurrences. The use of advanced or progressive cases the first line treatment somatostatin analogues, drugs capable of inhibiting is corticosteroids and immunomodulatory agents. The gastrin production, has been gaining ground in the main complications are related to fibrosis, shortening treatment of neuroendocrine neoplasms. Some studies and compression of mesenteric vessels. The surgical show that there is significant difference in gastrin approach should be limited to biopsy exploration levels and regression of lesions while in follow-up with and resection reserved for cases considered highly endoscopy, as well as lower recurrences in comparisons suspicious for malignancy. Concluding Remarks: to other approaches. Final comments: We present Mesenteric panniculitis is usually benign, but may be a two cases of type 1 GNET with good response to the sign of an underlying condition that may be more severe use of somatostatin analog. The choice reveals itself to and tomographic findings depend on the stage of the be a therapeutic alternative and a possibility to select disease and the predominant component showing the patients with the best response to the posterior good correlation with pathological findings. approach with antrectomy. Contato: Janaina Gatto Contato: Ana Beatriz Tabosa Negrão Xavier [email protected] [email protected]
TEMÁRIO: TRATO GASTROINTESTINAL ALTO TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 87199 CÓDIGO: 88319 MODELO PROGNÓSTICO UTILIZANDO MESENTERIC PANICULITE IN PERITONIUM MARCADORES TUMORAIS PRÉ-OPERATÓRIOS AND OMENT: CASE REPORT NO CÂNCER GÁSTRICO Autores: Janaina Gatto / GATTO, J / FAG; Ana Clara Autores: Daniel Jose Szor / Szor, DJ / HCFMUSP; Andre Vieira Alexandre / ALEXANDRE, ACV / FAG; Julio Cesar Roncon Dias / Dias, AR / HCFMUSP; Marina Alessandra Zanini / ZANINI, JC / UOPECCAN; Gabriel Brisot / BRISOT, Pereira / Pereira, MA / HCFMUSP; Marcus Fernando G / UOPECCAN; Mariah Steinbach / STEINBACH, M / Kodama Pertille Ramos / Ramos, MFKP / HCFMUSP; UOPECCAN; Fernanda Kreve / KREVE, F / FAG; Francisco Bruno Zilberstein / Zilberstein, B / HCFMUSP; Ulysses Loss / LOSS, FS / FAG; Marilise Anne Zat / ZAT, MA / FAG; Ribeiro Junior / Ribeiro Jr, U / HCFMUSP; Ivan Cecconello Ivana Willington / WILLINGTON, I / FAG; Diego Aparecido / Cecconello, I / HCFMUSP. Gaspar / GASPAR, DA / UOPECCAN. Introdução: Os níveis séricos de determinados Case Presentation: A 53-year-old male patient presents marcadores tumorais podem aumentar em pacientes with dyspnea, severe abdominal pain accompanied by com adenocarcinoma gástrico (AG), em especial o CA19- vomiting, and lack of appetite for 7 days. Alcoholist 9, CA72-4 e o CEA. Devido à sua baixa sensibilidade e and smoker with previous diagnosis of liver cirrhosis. especificidade, sua utilização rotineira pré-operatória Physical examination showed pain on deep palpation não é recomendada pelos consensos. Porém, sabe-se of the abdomen without presence of mass or sign of que níveis elevados podem se relacionar com maior peritoneal irritation. An X-ray showing a distended grau de invasão tumoral, maior comprometimento bowel and an EDA with Pangastritis. Pain improvement, linfonodal e maiores taxas de recidiva tumoral após o hospital discharge. Returns in 10 days with vomiting. tratamento cirúrgico curativo. Objetivos: Estabelecer um Abdominal tomography reveals small intestinal modelo prognóstico pré-operatório baseado no CA72- loops grouped in the mesogastrium, with regular 4, Ca19.9 e CEA. Relacionar os marcadores tumorais thickening of its walls, kept under observation for 7 com características clínico-patológicas dos pacientes. days and palpable mass growth in the epigastric region. Metodologia: Foram avaliados retrospectivamente Biopsy by videolaparoscopy whose histopathological pacientes submetidos à gastrectomia entre 2009 e report showed peritoneum and omentum with 2017. Marcadores tumorais foram obtidos no período chronic mesenteric panniculitis with no associated de um mês antes da cirurgia e seu corte baseou-se em neoplastic infiltration in the samples and hypogastric consensos já estabelecidos. A sobrevida livre de doença peritoneum with chronic sclerosing mesenteritis. (SLD) foi avaliada através do método de Kaplan-Meier e Methylprednisolone treatment and immunosuppressive a diferença entre as curvas determinada pelo teste de therapy. Discussion: Mesenteric panniculitis is a rare Log-rank. Resultados: No período, 539 pacientes foram condition of inflammation in the mesentery. The most submetidos à gastrectomia curativa por AG. Foram involved is the small intestine mesentery followed by excluídos pacientes sem as medidas pré-operatórias de the mesocolon and rarely affecting the omentum and qualquer um dos três marcadores, o que resultou em pelvis. Its etiology is unknown, the most accepted being 97 casos (64% masculino, média de idade 63 anos). Os autoimmune alterations. It affects twice as many men valores de corte utilizados para CEA, CA19-9 e CA72.4 and between 50 and 60 years. The diagnosis is based foram de 5, 37 e 4 U/mL, respectivamente. Os pacientes on histopathology or radiology. Pathology findings foram divididos em 4 grupos de acordo com o valor range from mesenteric thickening to single or multiple, dos marcadores colhidos no pré-operatório: grupo A hardened or fibroelastic, encapsulated masses. (3 marcadores aumentados), grupo B (2 marcadores There may be fat necrosis as well as varying degrees aumentados), grupo C (1 marcador aumentado) e grupo
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D (nenhum marcador aumentado). Pacientes do grupo is a less rare mesenchymal tumor of the stomach (50 B e C apresentaram pior SLD quando comparados to 60%) and small intestine (20%). Its incidence among ao grupo D (p=0,003). Níveis de CA72-4 acima do all gastrointestinal tumors is approximately 1 to 3%. corte estão relacionados à tumores com invasão The initial diagnosis is made by abdominal and pelvic mais profunda da parede gástrica (p=0,018). Já níveis CT scans, and a significant percentage of patients (15 elevados de CA19-9 relacionam-se com parâmetros to 47%) show metastasis to the liver, peritoneum and inflamatórios elevados, como a relação neutrófilos- omentum at the diagnosis. Immunohistochemical linfócitos (p=0,045) e a plaquetose (p=0,029). O CA19-9 é examination is determinant for indication of systemic o único marcador que, quando acima do corte, mostrou therapy. In certain patients with CD 117 mutations there relação estatisticamente significativa com a recidiva are good results with adjuvant therapy with Imatinib. tumoral (p=0,03). Conclusão: Os marcadores tumorais In cases of irresectable GIST, adjuvant therapy with pré-operatórios podem ser utilizados em conjunto para imatinib is recommended, and subsequently surgical predição de sobrevida livre de doença após tratamento resection. Final comments: Good response to adjuvant cirúrgico curativo. O CA72-4 elevado relaciona-se com therapy for gastric GISTs indicates a good likelihood tumores mais invasivos e o CA19-9, além de indicar of surgical tumor resection, with good outcomes and maior probabilidade de recidiva, relaciona-se com acceptable survival. parâmetros laboratoriais inflamatórios elevados. Contato: Mariana Miranda Garcia Contato: Daniel Jose Szor [email protected] [email protected]
TEMÁRIO: TRATO GASTROINTESTINAL ALTO TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 88149 CÓDIGO: 87398 ONCOLOGIC SAFETY OF LAPAROSCOP- MULTIMODAL THERAPY IN SMALL GASTRIC IC GASTRECTOMY COMPARED TO OPEN GIST PROCEDURE IN TREATMENT OF GAS- Autores: Mariana Miranda Garcia / Garcia, M.M. / TRIC CARCINOMA: RETROSPECTIVE, FAMINAS-BH; Isabela Hermont Duarte / Duarte, I.H. / ANATOMOPATHOLOGICAL STUDY FAMINAS-BH; Luiza Ohasi de Figueiredo / Figueiredo, L.O. / Hospital Alberto Cavalcanti - FHEMIG; Bruno Aquino Autores: Fernando Augusto Vasconcellos Santos / Marcelino / Marcelino, B.A. / Hospital Alberto Cavalcanti Santos, F.A.V. / Oncad; Paula Segato Vaz de Oliveira / - FHEMIG; André Bicalho / Bicalho, A. / Hospital Alberto Oliveira, P.S.V. / Oncad; Ana Paula Drummond-lage / Cavalcanti - FHEMIG; Rafael Barbosa de Santis / Santis, Drummond-Lage, A.P. / Faculdade Ciências Médicas de R. B. / Hospital Alberto Cavalcanti - FHEMIG; Matheus Minas Gerais; Alberto Julius Alves Wainstein / Wainstein, de Castro Carvalho / Carvalho, M. C. / Hospital Alberto A.J.A. / Oncad. Cavalcanti - FHEMIG; Clarissa Santos Neto / Neto, C.S. / Hospital Universitário Ciências Médicas; Alberto Introduction: Laparoscopic gastrectomy is the procedure Waisntein / Waisntein A. / Hospital Alberto Cavalcanti - of choice in reference centers for treatment of early FHEMIG; Diego Paim Carvalho Garcia / Garcia, D. P. C. / gastric cancer. Despite proven reduction in morbidity, Hospital Alberto Cavalcanti - FHEMIG. the impact of the technique on cancer outcomes is still debated. Objective: To evaluate the oncological safety Case Description: A 43-year-old male patient sought of total and subtotal gastrectomy among patients medical care reporting hematemesis. The patient with gastrico carcinoma undergoing laparoscopic underwent upper GI endoscopy (EGD), which revealed resection compared to the open procedure. Methods: ulcerated and friable neoplasia in the subcardic wall Comparative, retrospective, anatomopathological study (Siewert III Borrman III), and a biopsy was performed involving patients with gastric carcinoma submitted to and confirmed the diagnosis of Gastrointestinal gastrectomy with D2 lymphadenectomy by laparoscopy Stromal Tumor (GIST). Computed tomography scan(CT) or laparotomy from 2011 to 2017. The variables analyzed showed a large expansive mass of 19.6 x 10.1 cm in were: gender, age, preoperative physical status by the its largest diameter, in the small gastric curvature in American Society os Anesthesiologists classification contact with the body and tail of the pancreas. The location, tumor size and depth in the gastric wall, patient was then submitted to preoperative staging histological classification (Lauren), extent of gastrectomy, and exploratory laparotomy with perioperative surgical margins, number of harvest lymph nodes, identification of an unresectable tumor. The patient oncologic staging. Results: In the period evaluated, 32 was referred to a specialized cancer surgery team and laparoscopic gastrectomies and 72 open gastrectomies advised to perform systemic therapy with Imatinib. with D2 lymphadenectomy were performed for gastric After the adjuvant therapy, a CT scan was requested cancer treatment. The groups presented similar for a new staging. A regression of 50% in tumor size profiles regarding the characterization by sex, age, was identified, presenting at that moment dimensions American Society of Anesthesiologists classification, of 10.8 x 5.6 cm. During the new surgical approach, tumor location, extent of gastrectomy and histological invasion of the body and tail of the pancreas and splenic classification. Among the patients submitted to the artery was noted and a total gastrectomy with partial laparoscopic procedure, the following were evidenced: pancreatectomy, and splenectomy were performed, smaller resected tumor size, less extension of gastric followed by Roux-en-Y reconstruction. Discussion: GIST transmural invasion and less advanced oncologic stages. The percentage of free surgical margins between the
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techniques was similar. Despite the lower lymph node mesenquimais gastrointestinais, 5% de todos os harvest in the laparoscopic technique (26.50 ± 10.43 vs sarcomas e 3% de todas as neoplasias do trato digestivo. 33.73 ± 13.43, p = 0.009), the value obtained met the Tipicamente, mais de 95% dos GIST são positivos international criteria for successful staging and surgical para a proteína KIT (CD117) pela coloração IHC, e em treatment of gastric cancer. Conclusion: Laparoscopic torno de 80% a 90% dos GIST apresentam mutação gastrectomy provides adequate oncological safety nos genes c-KIT ou PDGFRA. Objetivo: Analisar dados regarding the number of resected lymph nodes and the como sexo, idade, localização e estágio do tumor no surgical margins obtained. momento do diagnóstico em pacientes tratados em Serviço Oncológico (UNACON) de Referência do Vale Contato: Fernando Augusto Vasconcellos Santos do Taquari-RS e comparar com a literatura. Método [email protected] Estudo epidemiológico retrospectivo, quantitativo, observacional e descritivo do tipo análise de casos através da coleta de dados de prontuários de pacientes TEMÁRIO: TRATO GASTROINTESTINAL ALTO portadores de GIST No período de 01 de janeiro 2006 a CÓDIGO: 87530 31 de dezembro de 2017. Resultados: Encontramos 9 pacientes com diagnóstico de GIST - 5 (55,6 %) mulheres PALLIATIVE BILIARY DRAINAGE IS BENEFICIAL e 4 (44,4 %) homens. A idade mínima obtida foi de 49 IN PATIENTS WITH NON-PRURITUS anos e a máxima foi de 82 anos. A média de idade foi 69 anos (DP=10 anos) e o estômago o principal sítio ASSOCIATED MALIGNANCY “ (77,8 %), seguido do intestino delgado (22,2 %). Três Autores: José Luiz Bravin Júnior / Bravin J.L. / Fundação pacientes apresentavam metástases ao diagnóstico Cristiano Varella ; Edson Augusto Ribeiro / Ribeiro E. / porém o estágio pT3N0M0 foi o mais prevalente. Fundação Cristiano Varella; Leandro Siqueira Correa Conclusão: Os dados coletados permitem inferir que / Correa L. / Fundação Cristiano Varella; Rinaldo os pacientes portadores de GIST tratados em nosso Gonçalves / Gonçalves R. / INCA. Serviço tem uma idade média pouco maior do que a encontrada na literatura e são predominantemente Pancreatic and biliary confluence tumors are extremely mulheres. O estômago é o sítio primário mais comum aggressive. With most of these tumors being unresectable e o fígado o principal sítio de metástases, dados que in their presentation. Among the symptoms affecting corroboram os resultados vistos em diversos estudos. these patients, obstructive jaundice is present in up to 90% of cases causing significant negative impact on Contato: Caroline Dalla Lasta Frigeri these patients‘ quality of life. Bile duct drainage has been [email protected] routinely employed as an efficient way of alleviating this symptomatology. The benefit of palliative biliary drainage in jaundice patients secondary to non-pruritic TEMÁRIO: TRATO GASTROINTESTINAL ALTO malignant obstruction is a matter of debate. We report CÓDIGO: 85675 the case of an 88-year-old white female patient with gallbladder tumor and invasion of the hepatic hilum who PRIMARY MALIGNANT ESOPHAGEAL determined obstructive jaundice who underwent biliary MELANOMA: CASE REPORT drainage despite the absence of associated pruritus. Objective and subjective improvements in appetite Autores: Gustavo Torres Lopes Santos / Santos, and food intake, control of digestive symptoms, as well G.T.L. / LIGA NORTERIOGRADENSE CONTRA O as emotional and social well-being were observed. We CANCER -RN; Abires de Arruda Junior / Junior, A.A / believe that palliative drainage in patients with malignant LIGA NORTERIOGRADENSE CONTRA O CANCER -RN; biliary obstruction should be discussed on a case-by- Francyjane Emanuela Ferreira Mesquita Silva / Silva, case basis, taking into account the quality-of-life benefit F.E.F.M. / UNP - RN; Marjorie Ravena de Oliveira Pereira observed even in patients without associated pruritus. Borges / Borges, M.R.O.P. / UNP - RN; Barbara Paulo Cavalcante / Cavalcante, B.P. / UNP - RN; Gabriela Contato: Bruno Pacheco Benneti de Grande Santos / Santos, G.B.G. / UNP - RN. [email protected] Introduction: Primary malignant esophageal melanoma (MMPE) is a rare neoplasm and by 2011, less than TEMÁRIO: TRATO GASTROINTESTINAL ALTO 340 cases had been reported in the literature. This CÓDIGO: 87886 melanoma is characterized by aggressiveness, with multiple and early metastases. Radical esophagectomy PERFIL DOS PACIENTES PORTADORES DE with lymphadenectomy is the treatment of choice. Objectives: To discuss the clinical presentation, TUMORES ESTROMAIS GASTROINTESTINAIS diagnosis and therapeutic management of primary (GIST) NO SERVIÇO REGIONAL DE ONCOLOGIA esophageal melanoma. Methodology: Case report (UNACON) DO VALE DO TAQUARI-RS of a patient diagnosed with MMPE. Case Report: M.D.B., 79 years old. Complaint of dysphagia. Physical Autores: Elisa Hoerbe Drescher / Drescher, E. H. / examination: no changes. EDA showing vegetative Univates ; Claudete Rempel / Rempel, C. / Univates; lesion, multilobulated, 32cm from the ADS, reaching the Caroline Dalla Lasta Frigeri / Frigeri, C. D. L. / Hospital luminal space, measuring 2.0cm. Anatomopathological Bruno Born e Univates; evidence of malignant neoplasia of epithelioid cells. Staging showed perigastric lymph node enlargement, Introdução: Os Tumores Estromais do Trato and total esophagectomy plus lymphadenectomy was Gastrointestinal (GIST) representam 80% dos tumores
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indicated. At biopsy, multinodular growth melanoma lesion in the gastric body, on the anterior wall and small with focally junctional activity was detected, maximum distal segment curvature transition, measuring about invasion thickness of 9 mm, mitotic index equal to 5 1.8 cm, bottom with hematic remnants, dark, elevated mitoses / mm³ without angiolymphatic and perineural edges, regular limits (BORMANN III). Histopathology invasion and IHC: revealed negative AE1 / AE3 and compatible with poorly differentiated adenocarcinoma. CD45 RO cytokines and Melan -A, HMB-45, SOX10 and Computed tomography (CT) of the initial abdomen with Protein S100 positive. In addition, metastases were image of thickening of irregular contours in transition identified in one periesophageal and one celiac lymph from body to antrum and absence of lymph node node. Discussion and results: In 1906, Baur described enlargement. As staging, it was necessary to perform the first case of MMPE. The clinical picture in more than Roux-en-Y gastrectomy, D2 lymphadenectomy and 70% of patients denotes complaints of dysphagia and cholecystectomy. The anatomopathological examination late onset epigastric pain. The diagnostic criteria for of the surgical specimen was a poorly differentiated MMPE are: 1) typical histological pattern of melanoma, carcinoma about 7cm long, infiltrating the entire gastric with melanin granules within the tumor cells and 2) wall and perivisceral adipose tissue, with angiolymphatic origin in an area of junctional activity in the squamous and perineural invasion, surgical margins free of epithelium. The association of these criteria with the neoplasia, and 14 affected lymph nodes out of 52. presence of melanoma in situ without previous history Immunohistochemistry showed positivity for squamous of cutaneous melanoma leads to the absolute diagnosis cell carcinoma type, p63 positive. Thus, we opted of MMPE. Treatment should be individualized and, when for adjuvant chemotherapy treatment, performing possible, surgery is the preferred method, with radical 8 cycles until June 2018, after 13 months remaining resection with wide margins being recommended. asymptomatic and without evidence of disease. As for prognosis, the average survival after surgical Discussion: Gastric squamous cell carcinoma (GSCC) treatment is less than 15 months and about 85% of is an extremely rare histological type, responsible for patients with MMPE die from disseminated disease. an incidence of less than 1% of primary tumors of this Conclusion: Therefore, MMPE is a rare neoplasm organ. In terms of occurrence, it is more common in men derived from esophageal melanocytes and usually in the sixth decade of life, usually caucasian and presents has a late diagnosis and poor prognosis. We report in more advanced stages. It mostly originates from the the case of a 79-year-old female patient diagnosed proximal stomach and there is no standard treatment with MMPE who underwent total esophagectomy with in the literature. Despite the uncertain pathogenesis of lymphadenectomy, with metastases in perigastric and gastric cardiopulmonary bypass, there is a consensus celiac lymph nodes. Patient in clinical follow-up. within the literature that it is an aggressive histological type, where it commonly occurs with lymph node and Contato: Gustavo Torres Lopes Santos liver metastases. To date, there is no definite treatment, [email protected] and surgical resection is the most common treatment modality reported in the literature, although half of the patients with this tumor histological type have metastatic TEMÁRIO: TRATO GASTROINTESTINAL ALTO disease. However, treatment with radical surgery CÓDIGO: 88029 and adjuvant chemotherapy has been shown to be appropriate in some studies. PRIMARY SPINOCELLULAR CARCINOMA OF THE STOMACH: A CASE REPORT IN WESTERN Contato: Renata Maravieski Pareja [email protected] AMAZON Autores: Renata Maravieski Pareja / Pareja, R.M. / Universidade do Estado do Amazonas; Lailson TEMÁRIO: TRATO GASTROINTESTINAL ALTO Melgueira Navarro / Navarro, L.M. / Universidade do CÓDIGO: 88065 Estado do Amazonas; Rejaine Ribeiro Vilela / Vilela, R.R. / Universidade Nilton Lins; Sarah Susan Rodrigues PROFILE ANALYSIS OF GASTRIC CANCER Tavares / Tavares, S.S.R. / Universidade Federal do PATIENTS IN A PUBLIC HEALTH SERVICE IN Amazonas; Maxine Aguiar Damasceno / Damasceno, BELO HORIZONTE M.A. / Universidade do Estado do Amazonas; Leandro Castro Breves / Breves, L.C. / Universidade do Estado Autores: Rafael Barbosa de Santis / de Santis, RB / do Amazonas; Angeli Alexandra Caro Contreras Hospital Alberto Cavalcanti, FHEMIG; Mariana Miranda / Contreras, A.A.C. / Universidade do Estado do Garcia / Garcia, M. M. / Hospital Alberto Cavalcanti, Amazonas; Larissa Pessoa de Oliveira / Oliveira, L.P. / FHEMIG; Laísa Gabrielle Silva / Silva, L.G. / Hospital Universidade Federal do Amazonas; Gilmara Anne da Alberto Cavalcanti, FHEMIG; Patrick Teixeira Gomes Silva Resende / Resende, G.A.D.S. / Fundação Centro de Talma / Talma, P.T.G. / Hospital Alberto Cavalcanti, Controle de Oncologia do Estado do Amazonas; Rebeca FHEMIG; Diego Paim Garcia / Garcia, D.P. / Hospital Aparecida dos Santos Di Tommaso / Tommaso, R.A.S. / Alberto Cavalcanti, FHEMIG; Ana Paula Drummond-lage Fundação Centro de Controle de Oncologia do Estado / Drummond-Lage, A.P. / Faculdade Ciências Médicas de do Amazonas. Minas Gerais; Alberto Julius Alves Wainstein / Wainstein, A.J.A. / Hospital Alberto Cavalcanti, FHEMIG. Case Presentation: A 40-year-old male patient reported a history of postprandial fullness and epigastralgia, Introduction: Gastric cancer (GC) is the fifth most nausea, hyporexia, and weight loss of approximately common cancer in the world, with an incidence of 10kg in 2 months. He underwent upper digestive 13.5 / 100000 people, and the third most lethal. About endoscopy, which revealed ulcerated and infiltrative 90% of these tumors are adenocarcinomas, affecting
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mostly men around 60-70 years. Among the risk factors significant weight lost. A digestive endoscopy revealed for this condition, the main one is H. Pylori infection, sliding hiatal hernia and an irregular, ulcerated lesion in and others such as improper diet, obesity, alcohol the upper area of the lesser curvature, diagnosed as a and cigarette abuse, and positive family history. As for well-differentiated gastric adenocarcinoma. The patient symptomatology, most patients complain of dyspepsia, was submitted to a total gastrectomy with an Y-de-Roux postprandial stacking, and weight loss. To make the reconstruction, evolved with diffuse peritonitis in the diagnosis is required, Upper Digestive Endoscopy (UDE) postoperative and was submitted to an exploratory and fragment biopsy. Objective: To analyze the profile laparoscopy that revealed an abcess in the right iliac of gastric cancer patients treated by the oncologic fossa and purulent peritonitis. The abcess was drained surgery team from 2018 to July / 2019, as well as to make and the KPC bacteria was isolated. Discussion Stomach a comparison with the profile found in the literature. cancer, most commonly gastric adenocarcinoma, Method: Review of the medical records of patients with is the fifth most frequent cancer in women and the gastric adenocarcinoma from 2018 to July 2019, seeking fourth most frequent in men, with a higher incidence to find age, gender, symptomatology, complementary after the fortieth decade of life. Although treatment exams, and their characteristics, neoadjuvant. Also, we is multidisciplinary, surgery offers higher chances of performed a literature review in Pubmed. Results: We disease control. This conduct is determined by the evaluated 38 patients, 19 women and 19 men, 20 (52.6%) location, size and capacity of reaching clean margins patients aged 60 to 80 years. Epigastric pain (84.2%) when dissecting the tumor, and when the carcinoma was the most prevalent symptom, followed by weight is located in the proximal third of the stomach a total loss (63.2%). Regarding location, third distal tumors gastrectomy is indicated. This technique, however, were the most prevalent, 17 (44.7%), followed by gastric when compared to a subtotal gastrectomy, presents esophageal junction tumors, 14 (36.8%). Computed 15,9% of complications, higher chances of postoperative tomography of the chest and abdomen is applied to comorbidities and infection susceptibility (27,8%), as perform staging. In 16 (42.1%) patients, perigastric stated in the report, in which the patient evolved to a lymph node enlargement and 17 (44.7%) gastric wall purulent peritonitis due to carbapenemase-producing thickening were identified. In 37 (97.4%), no magnetic Klebsiella pneumoniae (KPC). Final considerations In the resonance imaging, PET-CT, endoscopy or laparoscopy case analysis, the presence of the tumor in the proximal were performed as a study complement. Most patients third of the stomach is emphasized, and is what were at a more advanced stage, being 8 (33.3%) stage III motivated a total gastrectomy. Besides postoperative and 7 (29.2%) stage IV. Eight (21.6%) patients underwent complications being frequent in this type of procedure, neoadjuvant therapy, with exclusive chemotherapy infection and abcess cases are uncommon. Despite being the most established modality. Regarding that, the Enterobacteriaceae family, to which the KPC surgery, 27 (71.1%) patients underwent open surgery, belongs to, is the principal cause of spontaneous and 11 (28.9%) did not undergo surgery. Conclusion: bacterial peritonitis, and a study by Alves and Behar The profile of these patients is characterized by the demonstrated that the profile of the patient affected prevalence of the elderly, with no age difference. Distal by KPC is male, over the sixtieth decade of life and third lesions were more prevalent than other lesions. admitted in the surgical wing. In that sense, the patient Staging imaging exams showed locoregional disease whose case was previously reported fits in the classic in most patients. Most cases were at a more advanced presentation of this unusual complication. stage, and one-third of the patients did not undergo surgery due to advanced disease or clinical issues that Contato: Matheus Madureira Fernandes prevented the surgery. [email protected]
Contato: Rafael Barbosa de Santis [email protected] TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 87735
TEMÁRIO: TRATO GASTROINTESTINAL ALTO REMNANT GASTRIC CANCER: AN USUAL CÓDIGO: 87224 GASTRIC TUMOR OR A DISEASE WITH ITS OWN CHARACTERISTICS? PURULENT PERITONITIS CAUSED BY KLEBSIELLA PNEUMONIAE (KPC) IN A PATIENT Autores: Marcus Fernando Kodama Pertille Ramos SUBMITTED TO TOTAL GASTRECTOMY DUE / Ramos, M.F.K.P. / Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina da USP; Marina TO GASTRIC ADENOCARCINOMA: A CASE Alessandra Pereira / Pereira, M.A. / Instituto do Câncer, REPORT Hospital das Clínicas, Faculdade de Medicina da USP; Andre Roncon Dias / Dias, A.R. / Instituto do Câncer, Autores: Luisa Dutra de Castro / Castro, L. D. / Hospital das Clínicas, Faculdade de Medicina da USP; Universidade Federal Fluminense; Matheus Madureira Leandro Cardoso Barchi / Barchi, L.C. / Instituto do Fernandes / Fernandes, M. M. / Universidade Federal Câncer, Hospital das Clínicas, Faculdade de Medicina da Fluminense. USP; Osmar Kenji Yagi / Yagi, O.K. / Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina da USP; Case report I. S., 60 years old, male, alcoholic, was Amir Zeide Charruf / Charruf, A.Z. / Instituto do Câncer, admitted with a sudden case of hematemesis, syncope Hospital das Clínicas, Faculdade de Medicina da USP; and seizure. Developed strong intensity epigastralgia Anna Carolina Batista Dantas / Dantas, A.C.B. / Instituto as a burning sensation related to food ingestion that do Câncer, Hospital das Clínicas, Faculdade de Medicina was alleviated with the use of omeprazole as well as
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da USP; Ulysses Ribeiro Jr / Ribeiro Jr, U. / Instituto do Cavalcante Ferro Neto / Neto, O. C. F. / Santa Casa Câncer, Hospital das Clínicas, Faculdade de Medicina de Misericórdia de Maceió; Filipe Augusto Porto da USP; Bruno Zilberstein / Zilberstein, B. / Instituto do Farias de Oliveira / Oliveira, F. A. P. F. / Santa Casa de Câncer, Hospital das Clínicas, Faculdade de Medicina da Misericórdia de Maceió; Aldo Vieira Barros / Barros, USP; Ivan Cecconello / Cecconello, I. / Instituto do Câncer, A. V. / Santa Casa de Misericórdia de Maceió; Robério Hospital das Clínicas, Faculdade de Medicina da USP. Silva Melo / Melo, R. S. / Santa Casa de Misericórdia de Maceió; Diego Windson de Araújo Silvestre / Silvestre, Background: Remnant gastric cancer (rGC) has been D. W. A. / Santa Casa de Misericórdia de Maceió; defined as a tumor that develops in the stomach after Tainá Santos Bezerra / Bezerra, T. S. / Santa Casa de previous gastrectomy. There is a common sense that Misericórdia de Maceió; Thiago Yamamoto Amaral / rGC usually presents with more advanced clinical stage Amaral, T. Y. / Santa Casa de Misericórdia de Maceió; and distinct dissemination pattern leading to worse Elson Alexandro Cordeiro Folha Filho / Filho, E. A. C. prognosis. However, few studies have addressed this F. / Santa Casa de Misericórdia de Maceió; Alberson issue as well as its management in the Literature. Maylson Ramos da Silva / Silva, A. M. R. / Santa Casa de Objective: to evaluate the clinicopathological Misericórdia de Maceió. characteristics and prognosis of rGC after previous gastrectomy for benign disease. Methods: We Introduction: Currently, perioperative treatment of retrospectively reviewed all rGC surgeries between locally advanced gastric cancer has shown satisfactory 2009 and 2019. As a comparison group, patients with results with improved disease-free overall survival. primary GC of corpus/fundus/cardia who underwent Accurate staging is essential for therapeutic decision. total gastrectomy (TG) were selected. Results: A total It is essential to define the extent of the disease and of 39 patients with rGC and 120 submitted to TG were direct the conduct, avoiding unnecessary procedures. included. The mean interval between the first and second Laparoscopy is extremely sensitive in detecting intra- operation was 36.4 years. Billroth II was the previous abdominal metastases, with a staging change of reconstruction in all cases. Tumor location was at the about 50% according to Feussner‘s study. Objective: gastric corpus along the previous anastomosis in 27 rGC. To evaluate the role of laparoscopy in changing Compared to TG group, rGC patients were older (68.1 vs clinical staging and therapeutic approach, correlating 62.6 years, p=0.002) and had lower number of resected with tomographic findings.Objective: To evaluate the lymph nodes(LN) (43.4 vs 24.4, p<0.001). No differences role of laparoscopy in changing clinical staging and wer observed regarding comorbidities, tumor size, therapeutic approach, correlating with tomographic Láuren´s type, tumor grading, lymphovascular invasion, findings. Method: Retrospective study with database pT, pN and pTNM between the groups. Perioperative analysis of a reference service at Maceió, of patients mortality was higher for rGC (12.8% vs 5.8%) but without with locally advanced gastric adenocarcinoma with significance (p=0.169). The 5-years disease-free survival indication for neoadjuvant treatment (cT3 / T4, N +, (DFS) rate was 61.8% and 72.6% for rGC and TG patients, M0) who underwent staging laparoscopy (LE). , from respectively. The most common site of recurrence was 2017 to 2019. Results: 20 patients were analyzed, the peritoneal, particularly for rGC (61.5% vs 45.2%, p=0.322). average age was 62 years (9 female and 11 male). In Locoregional/LN recurrence was similar (38.5 % vs clinical imaging, 6 patients were T3, 14 patients, T4 35.5%). No significant difference in DFS was observed and 4 were N +. There was a change in staging in 40%, between rGC and TG patients with pN0 (87.5% vs 95.2%, 3 patients initially T3, became T4 after laparoscopy. In p=0.379) and with pN+ status (38.9% vs 59.2%, p=0.592). the assessment of N, only 1 patient who was initially When adjusted for pTNM stage, DFS was significantly N0 went to N +. Four patients changed staging to worse only for stage I rGC (81.8% vs 100%, p=0.016). M1 due to peritoneal involvement and 1 patient, The 5-years overall survival rates were 56.4% and 69.2% initially defined as potentially M1 (peritoneum), for rGC and TG (p=0.546). Multivariate analysis did not showed no neoplastic involvement in peritoneum demonstrate rGC as a prognostic variable compared and peritoneal fluid. This change reflected directly to TG for both DFS and OS. Conclusion: Remnant GC in the prognosis. Of the 20 patients, 65% underwent had similar clinicopathological characteristics to primary neoadjuvant chemotherapy (FLOT regimen) and 35% GC. Despite the lower number of resected LN, rGC had were referred for palliative treatment. No patient similar prognosis even when adjusted for different had perioperative complications. Of those submitted covariables. Higher perioperative mortality risk must be to neoadjuvant therapy, 30% (6 patients) underwent considered in these cases. curative surgical treatment with gastrectomy and DII lymphadenectomy. At follow-up, 25% of Contato: Marcus Fernando Kodama Pertille Ramos patients (5) completed treatment and continued [email protected] without evidence of disease. Disease progression in neoadjuvant treatment occurred in 15% of the cases and one patient died during the first preoperative TEMÁRIO: TRATO GASTROINTESTINAL ALTO FLOT cycle.Conclusion: Laparoscopy was superior CÓDIGO: 87519 to tomography in the staging of gastric neoplasia in this series, with consequent change in treatment and ROLE OF LAPAROSCOPY IN GASTRIC CANCER prognosis of patients. The procedure also proved STAGING: EXPERIENCE OF A REFERENCE safe and effective as there were no perioperative complications. SERVICE IN CANCER SURGERY IN MACEIÓ Autores: Amanda Lira dos Santos Leite / Leite, A. L. Contato: Amanda Lira dos Santos Leite S. / Santa Casa de Misericórdia de Maceió; Oscar [email protected]
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TEMÁRIO: TRATO GASTROINTESTINAL ALTO the patient‘s own characteristics, showing that the CÓDIGO: 88323 conduct and medical evaluation of the case should be done, taking into account not only the protocols, SPECIFIC EVALUATION FOR SURGICAL MAN- but also also literature to guide better conduct. AGEMENT OF THE METASTASTIC GASTRO- Contato: Giovanni Luigi Ariza Calvario ESOPHAGEAL JUNCTION ADENOCARCINOMA [email protected] Autores: Giovanni Luigi Ariza Calvario / Calvario, GLA / Santa Casa de Porto Alegre; Gustavo Andreazza Laporte / Laporte, GA / Santa Casa de Porto Alegre; TEMÁRIO: TRATO GASTROINTESTINAL ALTO Fernanda Togni / Togni, F / Santa Casa de Porto Alegre; CÓDIGO: 87273 Izadora Bouzeid Estacia da Silveira / Silveira, IBE / Santa Casa de Porto Alegre; Gabriela Salzano Silva / SURGERY OF GASTRIC CANCER PATIENTS Silva, GZ / UFCSPA; Davi Carlos Brun / Brun, DC / Santa SUBJECT TO GASTRECTOMY AT OPHIR Casa de Porto Alegre; Rodrigo de Pieri Coan / Coan, LOYOLA HOSPITAL RP / Santa Casa de Porto Alegre; Leonardo Cousseau Borges / Borges, LC / Santa Casa de Porto Alegre; Autores: Leandro de Sousa Coelho / Coelho, L. S. / Junior Gil Vicente / Vicente, JG / Santa Casa de Porto Hospital Ophir Loyola; Marcos de Souza Lopes Freire Alegre; Lucas Gonçalves Matte / Matte, LG / Santa Casa Filho / Freire Filho, M. S. L. / Hospital Ophir Loyola; de Porto Alegre. Patricia Isabel Bahia Mendes Freire / Freire, P. I. B. M. / Hospital Ophir Loyola; Ana Caroline Sobrinho Dias Objectives: To report the case of a patient / Dias, A. C. S. / Hospital Porto Dias; Henrique Acácio with metastatic gastroesophageal transition Barbosa / Barbosa, H. A. / Hospital Porto Dias; Fábio adenocarcinoma who underwent esophagectomy and Sales Frota / Frota, F. S. / Hospital Porto Dias; Eduardo gastrectomy, with mediastinal lymphadenectomy. Duarte Espíndola / Espíndola, E. D. / Hospital Porto Dias; Methods: Presentation of a case with cardioplasty Ruan Gabriel Pinho Botelho dos Santos / Santos, R. G. P. surgical intervention after individual case evaluation B / Hospital Porto Dias; Lucas Jervan Miranda Meireles / and literature review. Result: A 30-year-old male Meireles, L. J. M. / Hospital Porto Dias. patient, on February 5, 2016, is referred to the oncology service of a referral hospital in Porto Cancer, in general, is a worldwide public health issue, Alegre. Family history of mother with breast cancer with a 20% incidence increasement over the last at 49 years and maternal cousin with breast cancer decade. Last year in Brazil, 12,920 new cases of stomach at 35. Diagnosed with cardia adenocarcinoma at cancer in men and 7,600 in women are esteemed out of 29 years, staged in liver T2NxM1, confirmed by 420,310 new cases. Corresponding to 6.0% and 3.7% of biopsy and HER2 +++ marker. On consultation, new cases, by gender, respectively. In the North region, he was treated with EOX (Epirubicin -50mg / m2-, this category is the second most frequent, with an Oxaliplatin -130mg / m2-), Capecitabine -625mg / incidence of 11.62 / 100 thousand, in men; in women, it m2-, first cycle, fifth dose, but did not tolerate oral is the fourth most frequent category. In this context, the Capecitabine. After consultation, treatment change objective of this study is to analyze the survival rate of to FOLFOX (5-Fluorouracil, Leucovorin, Oxaliplatin) gastric cancer patients in the city of Belém, Pará, Brazil, with Herceptin and Transtuzmab, the latter being through a research protocol applied to patients who HER2-specific. May 31, return after third cycle with underwent gastrectomy in 2013, in a referral hospital, magnetic resonance imaging (MRI) with reduction in according to their medical records, recognizing the number and size of liver lesions. MRI corroborates the main surgical techniques used and how they improved maintenance of chemotherapy treatment. FOLFOX the survival of patients in this hospital. Retrospective with Herceptin completed 6 cycles on 08/31/16, descriptive study of quantitative and qualitative Tranzumab maintenance in use. MRI on 09/29/2018 approach. Based on the analysis of about 150 patients reports distal esophageal thickening, then requested with gastric cancer who underwent gastrectomy. The High Digestive Endoscopy with vegetating lesion in research protocol focuses on the initial symptoms, date the distal esophagus with confirmation biopsy of of first visit, date of surgery, pathological, microscopic, adenocarcinoma. As there was disease in JEG, surgery surgical factors, stomach location, relapse, adjuvant was proposed, although controversial because the therapy, survival, and patient characteristics (age, procedure is not the standard for metastatic disease. gender, and clinical presentation). As a result, patients However, a patient with 2 years of evolution, young undergoing gastrectomy surgery at the referral hospital and without evidence of new metastases, aggressive had a survival rate of 1 to 5 years or more after surgical local treatment with oncologic surgery was indicated. treatment. Men are the most frequent in comparison December 12, 2019 performed esophagectomy, with to females, with incidence around the 6th decade of mediastinal lymphadenectomy and gastrectomy, life. The main histological type was adenocarcinoma. performed by videolaparoscopy and thoracotomy The most commonly performed surgery was curative by laparoscopy. Pathology of the specimen purpose D2 lymphadenectomy. Thus, it is concluded indicates pT4-staged gastroesophageal junction that early stage tumors had a high cure and survival adenocarcinoma pN1. Postoperative plan of adjuvant rate, following a similar profile to those described in the FOLFOX (2 cycles), followed by FOLFOX (4 cycles). literature. Conclusion: Although controversial, according to the individual assessment of the case, the treatment Contato: Ana Caroline Sobrinho Dias was performed aiming at a better prognosis due to [email protected]
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TEMÁRIO: TRATO GASTROINTESTINAL ALTO Edgard Santos; Morgana Cabral Santos Pestana / CÓDIGO: 88353 Pestana, M. C. S. / Complexo Universitário Professor Edgard Santos; Victor Hugo Bomfim de Castro / Castro, SURGICAL RESECTION OF INTESTINAL V. H. B. / Complexo Universitário Professor Edgard METASTASIS FROM SCAPULAR CUTANEOUS Santos; Pablo Tarceu Nunes de Melo / Melo, P. T. N. / Complexo Universitário Professor Edgard Santos; MELANOMA Luis Sérgio Do Amaral Júnior / Amaral Júnior, L. S. / Autores: Jonadab dos Santos Silva / Silva, J. S. / UFF; Complexo Universitário Professor Edgard Santos; João Paulo Chevrand Latini de Almeida / Almeida, Jorge Luiz Andrade Bastos / Bastos, J. L. A. / Complexo J.P.C.L / UFF; Igor Duque Gonçalves da Silva / Duque, Universitário Professor Edgard Santos; Heitor Carvalho I. / UFF; Danielle Basta Delai / Delai, D.B. / UFF; Júlia Guimarães / Guimarães, H. C. / Complexo Universitário Raquel Nunes Souza / Souza, J.R.N. / UFF; Jadivan Leite Professor Edgard Santos; Herbert Ives Barretto Almeida de Oliveira / Oliveira, J. L / INCA; Marcelo Sá de Araújo / / Almeida, H. I. B. / Complexo Universitário Professor Araújo, M. S. / INCA; Edgard Santos.
Case Presentation: A 64-year-old female patient, with a Case Report: A 71-year-old female patient with history of cutaneous melanoma (Breslows depth 7.2 mm) a history of right breast cancer 23 years ago was in the scapular region 6 years ago, presented with fatigue, hospitalized for investigation of severe abdominal dyspnea, and chronic iron deficiency anemia for which she pain for 5 months, burning, localized in right had been treated with iron supplementation and blood hypochondrium and epigastrium, associated transfusion. Workup tests included colonoscopy and with vomiting and 7kg loss, despite of regular scintigraphy with 99m-technetium marked erythrocytes, bowel rhythm. It was referred regurgitation and which were rather inconclusive. Further investigation postprandial fullness. Abdominal ultrasonography with PET/CT evidenced lesions in the proximal jejunum showed echogenic nodule at segment IV. Magnetic and terminal ileum, associated with perilesional fat resonance imaging of the abdomen showed stranding. Double balloon enteroscopy-guided biopsy multifocal hepatic nodules - the largest with 5.5 cm in revealed dark-colored ulcerated ileal lesion, and biopsy segment III, suspected of a secondary nodule. Upper findings confirmed metastatic melanoma implantation. digestive endoscopy showed infiltrative lesion in the Segmental enterectomy was performed for both lesions, gastric fundus. Anatomopathological evidenced a and tumor histopathology exhibited two ulcerated well-differentiated gastric carcinoma. Colonoscopy lesions, both infiltrating the mucosa and the muscular showed nodular lesion at the ileocecal valve level, as layer, presenting with peritumoral melanophages well as polyps in the ascending colon. The biopsy was in the serosa layer, compatible with the diagnosis of compatible with a well-differentiated neuroendocrine gastrointestinal metastatic melanoma. Discussion: tumor in ileocecal valve and tubular adenoma with Even though gastrointestinal (GI) tract metastases are low-grade dysplasia in ascending colon. CT guided rare, cutaneous malignant melanoma (MM) figures liver biopsy was consistent with neuroendocrine among the main primary tumors that metastasize to neoplasia (low grade). It was decided to perform the GI tract due to its characteristic organotropism and total gastrectomy with D2 lymphadenectomy, due to high potential of dissemination. MM metastases are the greater severity of the condition. The resection mostly found in the small bowel, presenting with high of neuroendocrine tumor and eventual resection of morbidity and elevated mortality when left untreated liver metastases was proposed to be performed in a due to several complications such as bleeding, bowel second stage. Discussion: Gastric adenocarcinoma obstruction, perforation, or fistula, even when the lesion is the fifth most common neoplasm and the third is still small-sized. Final comments: Surgical resection is most lethal in the world. Surgery is the only cure a promising option for both locally curative therapy and and recurrence may occur even after complete palliative morbidity and mortality reduction. The optimal resection. Its diagnosis is well established through investigation for GI tract MM metastases includes upper digestive endoscopy and biopsy of suspected positron emission tomography/computed tomography lesions. Despite of the indolent development of (PET/CT) assessment due to its high sensitivity, which neuroendocrine tumors, they have the potential for overcomes the limitations of purely morphology-based metastasis and the liver is a relevant site. Metastasis imaging given that small bowel endoscopic investigation of neuroendocrine tumors is a common indication for is relatively limited. liver resection and it is the only curative option when compared to other techniques. Chemoembolization Contato: Jonadab Dos Santos Silva and radiofrequency ablation have grown as options [email protected] in the treatment of these lesions. Final comments: This case illustrates the importance of the correct investigation of metastatic lesions in patients with TEMÁRIO: TRATO GASTROINTESTINAL ALTO synchronous primary tumors. The liver biopsy CÓDIGO: 87649 allowed choosing the strategy with curative intention for gastric cancer. Considering that neuroendocrine SYNCHRONIC GASTRIC ADENOCARCINOMA tumor has a more indolent behavior, it can be AND NEUROENDOCRINE TUMOR OF ILEUM approached in a second moment with the aim of a disease free survival. WITH LIVER METASTASIS, A CASE REPORT Autores: Bianca da Silva Vinagre Nascimento / Contato: Bianca da Silva Vinagre Nascimento Nascimento, B. S. V. / Complexo Universitário Professor [email protected]
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TEMÁRIO: TRATO GASTROINTESTINAL ALTO TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 87077 CÓDIGO: 87653
SYNCHRONIC GASTRIC GIST, GASTRIC THE USE OF NASOENTERAL TUBE AND CAVITY ADENOCARCINOMA AND RECTUM DRAIN IN ONCOLOGIC GASTRECTOMY: IS ADENOCARCINOMA: CASE REPORT THERE A POSTOPERATIVE BENEFIT? Autores: Fernanda Gebin Galrão de França / França, Autores: Luciana Mata da Silva / Mata, L.S / Hospital do F.G.G / Instituto Brasileiro Controle do Câncer; Cancer de Pernambuco; Mário Rino Martins / Martins, Fernanda Gebin Galrão de França / França, F.G.G / M. R. / Hospital de Cancer de Pernambuco; Cecília Instituto Brasileiro Controle do Câncer; Mario Feitosa Araújo Carneiro Lima / Lima, C.A.C / Hospital de Cancer de Carvalho Freitas Filho / Filho, M.F.C.F / Instituto de Pernambuco; Aline Batista de Castro / Castro, A.B. Brasileiro Controle do Câncer; Margarethe Novaes / / Universidade Maurício de Nassau; Alexandre Coelho Novaes,M. / Instituto Brasileiro Controle do Câncer; Barcellos / Barcelos, A.C. / Universidade Maurício de Alexandre Ferraz da Costa / COSTA, A.F / Instituto Nassau. Brasileiro Controle do Câncer; Roberto Bertone / Bertone, R. / Instituto Brasileiro Controle do Câncer. Introduction: Gastrectomy with lynphadenectomy is considered the standard treatment for patients with Objective: To relate a rare case of synchronous gastric câncer,with morbiddity and mortality rates gastrintestinal tumors CASE REPORT. Patient A.Y.S., variating from 4.2 to 30.4% and 0 to 16%, respectively. female, 70 years old, Japanese. Reported history of Despite of the improvement in surgical quality, still positive occult intestinal bleeding in October 2018. exist doubts about the benefit of using cavity drain No other gastrointestinal complaints. She performed (CD) and nasoenteral tube (NET). Some services still colonoscopy in October 2018 identifying a rectal tumor use it routinely, however, sice the introduction of 5 cm from the pectineal line, a vegetating ulcerated postoperative recovery protocols, routine placement lesion with an extension of about 3 cm. Pathology of CD and NET is no longer indicated, as they don´t confirmed rectal adenocarcinoma and MRI study reduce postoperative complications, prolong confirmed T2N. In November 2018 a upper endoscopy hospitalization and don´t change the outcome. We and endoscopic ultrasound revealed a subepithelial observed a lack of randomized studies to evaluete lesion located in the gastric fundus measuring about 4 the use of CD and NET, making it necessary to analyze cm and 2cm antral ulcer measuring about 2.0 cm. The whether these measure are necessary for a favorable pathological examination of the antral ulcer confirmed outcome. Objective:To evaluate the length of stay adenocarcinoma and the subepithelial lesion Gastric and presence of postoperative (PO) complications stromal Tumor (GIST). Imaging Staging (computed of gastrectomy (total and subtotal) in patients whith tomography-CT) did not identify distant metastasis and gastric câncer, comparing the use or not of CD and tumor markers within normal range. Finally she was NET. Method: A prospective randomized intervention diagnosed with synchronous tumors in the stomach study conducted at a referral câncer surgery hospital (gastric fundus GIST and anthropiloric adenocarcinoma) with a total of 20 patients, until now, from January and middle rectum (adenocarcinoma), all with upfront to june 2019. Clinicophathological characteristics, surgical indication after multidisciplinary discussion. performance status (PS) and surgical complications The patient underwent partial gastrectomy with D2 were analyzed and described. Results: 20 patients lymphadenectomy, wedge gastrectomy in the gastric were randomized, of which 15 used NET and CD (group fundus and rectosigmoidectomy with protective loop 1), 10 underwent total gastrectomy and 5 subtotal ileostomy diversion on February 15, 2019. Patient gastrectomy (STG). The group that didn´t use CD and had a good surgical recovery with hospital discharge NET was composed of 5 patients (group 2) and all on the 10th postoperative day. The final staging after underwent GST. Group 1 had an average length of stay anatomopathological results of the surgical specimen of 11 days between surgical procedure and hospital was: GIST stomach 1B (T3N0M0), Adenocarcinoma discharge, while in group 2 the avarage was 6 days. We stomach 1A (T1aN0M0) and Straight adenocarcinoma had statistical significance in the analysis regarding the 1B (T2N0M0). No adjuvancy treatment needed and length of saty, comparing the two groups, with p <0.5. at the moment on follow-up. DISCUSSION AND FINAL Regarding the beginning of oral diet, group 1 started on CONSIDERATIONS GIST and adenocarcinoma are the 4th postoperative day and group 2 started on the distinct malignancies originating from different cell 1st postoperative day. 46.5% (7) of patients in group 1 layers and the simultaneous development of a GIST and had postoperative complications, the main one being gastric adenocarcinoma is relatively rare. Some studies pneumonia. In group 2, there were no complications. have shown that approximately 20% of GIST patients Regarding the analysis of PS, in group 1, it was 53% for develop other cancers, but it is still unclear whether this PS 1, 40% for PS 2 and 7% PS 0. In group 2, 60% had PS is just an accidental coexistence or whether they are 1 and 40% PS 2. Conclusion: The initial results are in related to a causal relationship. Thus, the report of this agrément with the findings described in the literature case, besides showing the rarity of three synchronous which indicate that the use of NET, associated with the tumors, shows the importance of investigating delayed initiation of oral diet, and use of CD, suggest synchronous tumors, enabling better oncological na increase in postoperative complications and a prognosis and treatment for the patient. grater length of hospital stay.
Contato: Fernanda Gebin Galrão de França Contato: Cecília Lima Carneiro [email protected] [email protected]
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TEMÁRIO: TRATO GASTROINTESTINAL ALTO TEMÁRIO: TRATO GASTROINTESTINAL ALTO CÓDIGO: 87487 CÓDIGO: 87407
TUMOR DE KRUKEMBERG UNILATERAL: UNEXPECTED EVOLUTION OF CHRONIC RELATO DE UM CASO GASTRITIS TO GASTRIC ADENOCARCINOMA Autores: ícaro de Azevedo Alexandre / Alexandre, I. AND SEVERE PYLORIC STENOSIS: A CASE A. / UFFS; Charles Nilton Gatelli / Gatelli, C. N. / HCPF; REPORT Renata Bruna García dos Santos Gatelli / Gatelli, R. B. G. Autores: Igor Duque Gonçalves da Silva / Duque, I. S. / HCPF; Rodrigo Fuzinatto Fiorentin / Fiorentin, R. F. / / Universidade Federal Fluminense - UFF; Jan-peter HCPF; Mônica Linhares Sachett / Sachett, M. L. / UFFS; Correia Sousa Périssé / PÉRISSÉ, J. C. S. / Universidade Keith Amanda Mann / Mann, K. A. / UPF; Bernardo Cenci Federal Fluminense - UFF. Basso / Basso, B. C. / UPF; Camilla Carmem Teixeira / Teixeira, C. C. / UFFS; Letícia Signori Kohl / Kohl, L. S. / Case Presentation: F.S.V., male, 53 years old, UFFS; Mariana Gregorio / Gregório, M. / UFFS. sought hospital care in May 2019 reporting weight loss of 17kg in the last 3 months and RELATO DO CASO Paciente, sexo feminino, 66 anos, vomiting. Upper digestive endoscopy performed em acompanhamento ambulatorial semestral pós- in April 2019, diagnosed with Los Angeles grade B tratamento adjuvante para adenocarcinoma gástrico esophagitis, Sakita antrum A1 gastric ulcer with (gastrectomia subtotal + FOLFOX) há 3 anos, apresenta mild pyloric stenosis, with negative urease test. queixas de dor em flanco inferior direito e exame de Biopsy confirmed mild chronic gastritis, referred imagem sugestivo de metástase em ovário ou novo for clinical treatment. In June 2019, the patient tumor primário. Realizada laparotomia oncológica para returned complaining of postprandial , vomiting retirada do tumor onde foi observado carcinomatose and acute fall in general condition, low food intake, peritoneal. Realizada então ooforectomia bilateral. worsening weight loss and constipation. A new Resultado anatomopatológico evidenciou metástase upper endoscopy was performed identifying severe gástrica em ovário direito. Iniciado acompanhamento erosive reflux esophagitis, infiltrating vegetative com Oncologia Clínica com esquema de tratamento de ulcerative lesion in the antrum, with poorly defined, primeira linha pra adenocarcinoma gástrico metastático. friable and soft consistency, affecting pylorus. Paciente atualmente em tratamento. DISCUSSÃO As Classified as advanced gastric neoplasia Borrmann metástases de tumores gástricos em ovários, também III complicated with pyloric stenosis (4mm in conhecidos como Tumores de Krukemberg, são diameter). On examination, a thin patient, paleness adenocarcinomas com células em anel de sinete. São (2 + / 4 +), anicteric, eupneic and normocardic. raros e responsáveis por 1-2% dos tumores do ovário. Denies dyspeptic complaints. No tangible masses. O tumor primário habitualmente está localizado no Social Alcoholist. Discussion: After Endoscopy and trato gastrointestinal e a localização mais frequente histopathology, subtotal gastrectomy with Braun é o estômago (70% casos). O tumor de Krukenberg é Billroth II reconstruction and D2 lymphadenectomy bilateral em cerca de 80% dos casos. As doentes com was indicated as the best approach for Borrmann Tumor de Krukenberg têm um prognóstico reservado, III distal gastric lesion. Gastric cancer is one of sobretudo se o tumor primário não for identificado. O the most common malignant neoplasia in the intervalo entre o diagnóstico de um carcinoma primário world. In Brazil , its the third most common type e a subsequente descoberta de envolvimento ovariano among men and the fifth among women. Stomach geralmente é de seis meses ou menos, mas períodos adenocarcinoma mostly affects men around 60- mais longos têm sido relatados. Em muitos casos, o 70 years old, and the main risk factors are: male tumor primário é muito pequeno. A rota metastática gender, H. pylori infection, smoking, alcoholism do câncer gástrico acontece nos ovários provavelmente and atrophic gastritis. In this case, there were no devido a disseminação linfática. No quesito significant risk factors to suggest such prognosis. epidemiologia acomete mais mulheres na quinta Normally the evolution of chronic gastritis to gastric década de vida. A sobrevida média após o diagnóstico cancer is a slow process because it depends on aproximadamente 14 meses. A paciente do caso era successive stages, and the risk ranges from 1 to 3%, sintomática e foi proposto o tratamento adequado, most frequently in individuals with extensive gastric segundo a literatura médica, após confirmação mucosa atrophy and intestinal metaplasia, mainly diagnóstica com quimioterapia para adenocarcinoma associated with H. pylori infection. Final comments: gástrico metastático no esquema de Oxaliplatina + The case presented draws attention for its rapid Leucovorin + 5-Fluoracil. CONDISERAÇÕES FINAIS and aggressive evolution with gastric cancer and O tumor de krukemberg apresenta-se raramente, vegetating ulcer lesion, without previous H. pylori principalmente na forma unilateral. Assim, mostra- infection, with mild atrophy and metaplasia, that are se importante relatarmos o caso, haja vista que havia also associated with severe pyloric stenosis, which uma dúvida diagnóstica entre ser um tumor primário is a complication presented in approximately 15% no ovário direito ou ser uma metástase tardia do of the lesions in the antrum region, which makes it adenocarcinoma gástrico apresentado anteriormente even more unusual. pela paciente. Contato: Igor Duque Gonçalves da Silva Contato: Ícaro de Azevedo Alexandre [email protected] [email protected]
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TEMÁRIO: TRATO GASTROINTESTINAL ALTO neoplasia being superstaging because the edema or CÓDIGO: 88328 inflammation, is the best diagnostic tool of precision and leads to better prognosis. USE OF ENDOSCOPIC ULTRASOUND IN THE SURGICAL MANAGEMENT OF EARLY Contato: Giovanni Luigi Ariza Calvario [email protected] ADENOCARCINOMA OF GASTRIC CARDIA: A CASE STUDY Autores: Giovanni Luigi Ariza Calvario / Calvario, GLA / TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL CÓDIGO: 87574 Santa Casa de Porto Alegre; Gustavo Andreazza Laporte / Laporte, GA / Santa Casa de Porto Alegre; Leonardo Cousseau Borges / Borges, LC / Santa Casa de Porto 8-MM PORTAL INCARCERATED HERNIA AFTER Alegre; Guilherme Zatti Fedrizzi / Fedrizzi, GZ / Santa ROBOTIC COLECTOMY: CASE REPORT Casa de Porto Alegre; Gunther Ayala / Ayala, G / Santa Michaella Luchesi Almeida / Almeida, M.L. Casa de Porto Alegre; Izadora Bouzeid Estacia da Silveira Autores: / Faculdade Ciências Médicas de Minas Gerais; João / Silveira, IBE / Santa Casa de Porto Alegre; Gabriela Victor Tavares Mendonça Garretto / Garretto, J.V.T.M Salzano Silva / Silva, GS / UFSCPA; Plauto Erasmo Beck / Faculdade Ciências Médicas de Minas Gerais; Thiago / Beck, PE / Santa Casa de Porto Alegre; Thomas Kelm / de Almeida Furtado / Furtado, T.A / Faculdade Ciências Kelm, T / UFSCPA; Ana Luiza Kolling Konopka / Konopka Médicas de Minas Gerais, Hospital Felício Rocho; / UFCSPA. Fernando Augusto de Vasconcellos Santos / Santos, F.A.V / Faculdade Ciências Médicas de Minas Gerais, Introduction: There´s a increase of neoplasia of the Hospital Felício Rocho; Diego Paim de Carvalho Garcia gastro-esophageal transition. In parallel, there was an / Garcia, D.P / Faculdade Ciências Médicas de Minas evolution in the diagnosis with the use of new methods Gerais, Hospital Felício Rocho. and precise indication of surgical and adjuvant therapy. According to the Protocols of the National A 72-year-old woman diagnosed with Comprehensive Cancer Network and the European Case Report: splenic angle adenocarcinoma of the colon and Society for Medical Oncology the indication of primary underwent through robotic left colectomy. On the 12th surgery in this pathology is for T1b tumors, remaining postoperative day, the patient developed vomiting mucosectomy for T1a and Tis tumors and neoadjuvant and stopped stool and flatus elimination. A computed therapy for tumors T2-4 . When staging, to evaluate the tomography showed hernia on the left flank with an depth of the tumor (T) and the involvement of lymph 8 mm orifice. Incisional hernia was diagnosed, then nodes (N), endoscopic ultrasound (EUS) is the most the patient underwent incisional herniorrhaphy to sensitive and specific method. Objectives: To report correct the defect and proceeded with a physiological the use of EUS for primary surgical indication in gastric postoperative period. Portal site hernia cardia neoplasia. The method provided adequate Discussion: (PSH) is defined as an incisional hernia following surgery management. Methods: Presentation of a case with involving the passage of trocars, whether robotic surgical intervention of a gastric cardia tumor after EUS or laparoscopic. These hernias are associated with and review of the literature. Results: Female patient, 46 patient-related risk factors and inherent risk factors years old, complaining of pyrosis and epigastric pain. of the surgical procedure itself. Factors related to the Submitted to upper digestive endoscopy that showed patient are obesity, diabetes mellitus, chemotherapy, in the Z line a erosion and in the gastric cardia a lesion smoking. The factors involved with surgery are the use of metaplastic appearance with edema in the region. of trocars with blade, duration of surgery, place of trocar Biopsy confirms the diagnosis of adenocarcinoma. insertion, excessive or inappropriate manipulation For staging a computed tomography was performed, of forceps during surgery, manner of insertion and without alterations. The EUS showed a vegetative removal of trocars, and failure or non-closure of trocar lesion with infiltrative borders of the mucosa and insertion. PSH have a low incidence and are related to submucosa, below the Z line, with about 4,7mm (T1B), the diameter of the trocar and its place of passage. Its defining the Videolaparoscopic esophagectomy with incidence in trocars of 10 mm or more is 0.8%, in 8 mm lymphadenectomy as primary oncological treatment. trocars of 0.68% and there are no reports of hernias in 5 The pathology demonstrated moderately differentiated mm portals. In 8 mm portals, the incidence of incisional adenocarcinoma with invasion of the mucosal muscle. hernia is low; however, when strangulation of straps Conclusion: With the use of the EUS we obtain in relation occurs, they are associated with high morbidity due to to the other imaging exams higher specificity and ischemia of the affected intestinal follow-up, requiring sensitivity (T with sensitivity of 81-90% and specificity in some cases surgical re-approach. of 99%. For N, sensitivity of 96.7% and specificity of Conclusion: Besides its rarity PSH can create serious intercurencies. 95,5% ). The accuracy of the EUS indicating invasion Therefore its necessary prevent and, when it happens, of the mucosa and submucosa, staging in T1b, defines adopt the right approach. The disturbances created by the conduct taken according to the current guidelines. passing 12 mm and 10 mm trocars should be closed. In the case reported above, the EUS enabled adequate Those created by 5 mm trocars do not need to be patient management, avoiding residual tumor or closed. The 8 mm trocars may or may not be closed only neoadjuvant therapy. The anatomopathological depending on the risk factors involved. examination of the surgical specimen was pT1a, revealing that the imaging method is reliable in the Michaella Luchesi Almeida management of cardia tumors. Therefore, despite Contato: [email protected] the limiting factor of the accuracy of the EUS in early
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TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL a defined treatment protocol, most patients solely CÓDIGO: 87595 undergo surgical treatment.
A RARE COLON CANCER Presentation: Contato: Tariane Friedrich Foiato MEDULLARY CARCINOMA (MC) [email protected] Autores: Tariane Friedrich Foiato / Foiato, T.F. / CEONC - Cascavel; Bruno Rafael Kunz Bereza / Bereza, B.R.K. / TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL CEONC - Cascavel; Eduardo de Biasio Milano / Milano, CÓDIGO: 88326 E.B. / Centro Universitário Assis Gurgacz; Tauana Karoline Friedrich Foiato / Foiato, T.K.F.F. / UniCesumar; ADENOCARCINOMA OF THE ANAL CANAL: Vitor Arce Cathcart Ferreira / Ferreira, V.A.C. / HU- CASE REPORT UFGD; Lucas Tanamati Wisnieski / Wisnieski, L.T. / Universidade Federal do Paraná; Ana Carolina Sayuri Autores: Ana Clara Vieira Alexandre / ALEXANDRE, Tanamati / Tanamati, A.C.S. / Universidade Federal do AnaCV / FAG; Janaina Gatto / Janaina, G / FAG; Julio Cesar Paraná; Alessandra Parmegiani de Biasio / Biasio, A. P. Zanini / ZANINI, JC / UOPECCAN; Mariah Steinbach / / Centro Universitário Assis Gurgacz; Mateus Oliveira STEINBACH, M / UOPECCAN; Gabriel Brisot / BRISOT, G / Damasceno / Damasceno, M.O. / UniCesumar; Phillipe UOPECCAN; Ivana dos Santos Willington / WELLINGTON, Geraldo Teixeira de Abreu Reis / Reis, P.G.T.A.R. / SI / FAG; Nathalia Kauka Cardoso / KAUKA, NC / FAG; University of Toronto. Marilise Anne Zat / ZAT, MA / FAG; Eduardo Milano / MILANO, E / FAG; Diego Aparecido Gaspar / GASPAR, DA Colon cancer is the third most incident neoplasia in the / UOPECCAN. world. A rare subtype of this disease is the medullary carcinoma (MC), consisting of only 0,03% of all colon Case Report: C.D.O, 53 years old, female, referred to carcinomas. This subtype was added to the WHO the service due to abdominal pain, fecal incontinence, databases in 2004, making it particularly new. MC is hematochezia and heartburn beginning 3 months more common in white populations being particularly ago, also reporting weight loss of 9 kg during the rare in populations of African origins. MC has a 2,12:1 same period. Smoker and former alcoholist. With female-male ratio. The average age of diagnosis is 64 y.o family history of sister with CA in uterus. Requested for males and 72 y.o for females. MC can be divided in colonoscopy that showed severe stenosis in the anal two subgroups: Undifferentiated Medullary Carcinoma canal, performed biopsy. Pathological examination (UMC) and Poorly differentiated Medullary Carcinoma showed adenocarcinoma. Exploratory laparotomy, liver (PDMC) with an incidence of 72% and 22% respectively. biopsy and sigmoidostomy. Evolved well after surgery, When compared to colon adenocarcinoma, MC has being discharged. Returning due to non-acceptance of a better prognosis due to rarely occurring distant oral diet, lack of appetite, severe pain and constipation. A and regional metastasis. The tumor growth is mainly new CT scan showed involvement of the anal canal, liver, non-glandular, solid, with intraepithelial lymphocytic peritoneal carcinomatosis and lymph nodes. Patient in infiltration and uniformly distributed malignant palliative care. Discussion: Malignant tumors of the cell layers. The prognosis is based on microsatellite anus and anal canal are rare entities, not exceeding unstability, due to p53 loss and CDX2 activation, which the rate of 2% of all tumors of the large intestine. Anal is frequently present in MC. The 05-year-survival rate canal adenocarcinoma can be subclassified into two in MC is of 64,9%. The mass found at the time of the types: (1) colorectal type - due to anal canal mucosa; (2) diagnosis was a stage T2 or T3, clinical staging IIA, with extra-mucous type - due to anal glands positioned at no lymph node involvement. The diagnosis is confirmed the level of the dentate line and fistulas. Pathogenesis by imaging exams, an increase in tumoral markers of this cancer is still not entirely clear. Factors such as and a biopsy of the lesion. The clinical presentation is Crohn‘s disease, chronic inflammation, HPV infection similar to other lower-GI tract tumors: abdominal pain, and pre-existing fistula were hypotheses raised and presence of blood in the stool and bowel obstruction. studied. Anal canal adenocarcinoma has a poor This case‘s patient is a 70 y.o, female patient with no prognosis, possibly due to late diagnosis of the disease. history of alcohol or tobacco use. The patient was It can spread both hematogenously and through referenced due to an abdominal pain with the duration lymphatic structures due to the combined blood supply of 01 year and a palpable, moving mass found during and lymphatic drainage of the anal canal. Unlike anal physical examination of the LRQ of the abdomen. MRI canal squamous cell carcinoma, adenocarcinoma results showed a heterogenous image at the ileocecal does not have a clear treatment strategy and several region with a 08cm diameter and augmentation of approaches may be offered such as radiotherapy, the surrounding lymphnodes (1,65cm). The patient chemotherapy, local excision and radical surgery. Final underwent a ileocolectomy and a retroperitoneal considerations:Although benign anal canal diseases lymphadenectomy. The final pathological staging are more common, in cases where there is a chronicity was T4aN1M0. The patient showed a good post-op of symptoms, alarm signs together, the diagnostic evolution. An adjuvant chemotherapy was prescribed hypothesis of anal canal adenocarcinoma should be (Folfox scheme). After 05 therapeutical cycles, the raised. The earlier the diagnosis is made, the better the patient underwent a PET-CET that showed no signs of prognosis. neoplasia. The patient showed a good clinical evolution, with no symptoms or signs of disease recurrence in Contato: Ana Clara Vieira Alexandre 10-month period. Because MC is a rare entity without [email protected]
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XIV Congresso Brasileiro de Cirurgia Oncológica
TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL Moreira Nunes / NUNES, N. S. M. / UNIVAG; Rosa Maria CÓDIGO: 87155 Elias / ELIAS, ROSA M. / UNIVAG; Rogério Leite Santos / SANTOS, ROGÉRIO LEITE / UNIVAG; José Eduardo de ADVANCED ANAL CANAL EPIDERMOID Aguilar-nascimento / DE AGUILAR-NASCIMENTO, JOSÉ CARCINOMA: CASE REPORT E. / UNIVAG.
Autores: Rodrigo Firmino Schirmbeck Moraes / Introduction: Colorectal cancer is a public health SCHIRMBECK, RODRIGO F. M. / UNIVAG; Natalia Santana problem, being the second leading cause of cancer Moreira Nunes / NUNES, N. S. M. / UNIVAG; Rosa Maria not considering skin cancer in women and the third Elias / ELIAS, ROSA M. / UNIVAG; Rogério Leite Santos in men. It is related to risk factors such as advanced / SANTOS, ROGÉRIO LEITE / UNIVAG; José Eduardo de age, smoking and lifestyle habits. Anal canal and anus Aguilar-nascimento / DE AGUILAR-NASCIMENTO, JOSÉ cancer are considered rare neoplasms, accounting E. / UNIVAG. for approximately 2% of malignant neoplasms and widely associated with human papillomavirus infection. Case Presentation. J.S.D, 59 years old, male, for one Epidemiologically, both diseases are more prevalent month presenting with anal discomfort associated with in the age group over 50 years. There are several liquid, bloody and purulent feces. Reports weight loss early screening methods for these diseases, such as of 8 kg in this period, without any alteration in appetite. Fecal Occult Blood Testing, rectosigmoidoscopy and Reports being a smoker (50 pack-year) and social drinker, colonoscopy, which are indicated for screening in with the consumption of about 2 litres of beer per week. patients with risk factors. Objective: To evaluate the At the proctological examination, a vegetative, friable and epidemiological profile of colorectal and anal cancers, bleeding lesion in the anterior-inferior wall of the anal taking into account age, sex, location of cancer and canal, less than 2 cm was evidenced. The colonoscopy mortality in the state of Mato Grosso as the main revealed a vegetative and friable lesion, approximately variables. Method: Retrospective analysis of 3,912 6cm long, from the anal canal to the distal rectum, hospitalizations due to colorectal cancer, anal canal performed biopsy. Histopathological examination and anus. Information was obtained from the DwWeb showed the diagnosis of invasive epidermoid carcinoma, inpatient system (SIH) notification system from 2000 to moderately differentiated (Grade 2). Magnetic 2018. RESULT: The most affected patients were male resonance imaging showed a concentric parietal (52.07%), aged over 50 years (68 , 20%; N = 2,668), with thickening of the middle inferior rectum, with contrast a mean of 56.72 years. Regarding length of hospital enhancement and obliteration of adjacent adipose stay, 22.16% remained for 8 to 14 days, with a mean planes, suggesting the possibility of a neoplastic nature. length of stay of 6.01 and a median of 5 days. About In addition, he presented small mesorectal lymph nodes, 43% (N = 1,687) of the patients had a diagnosis of hypodense foci in sparse T2 in the prostatic peripheral malignant rectal cancer, followed by ascending colon zone, nonspecific. Discussion: Anal canal cancer is with 19.50% (N = 763), sigmoid colon with 13.88 (N = considered a rare neoplasm, but each decade has 543), cecum with 9,89% (N = 387), transverse colon with shown a significant increase in its incidence, due to its 2.66% (N = 104), descending colon with 2.97% (N = 116), relationship with human papillomavirus infection. There anus with 4.22% (N = 165) and anal canal with 3.76% are other predisposing factors such as other sexually (N = 147). 17.4% (N = 679) of the patients required transmitted infections, anal intercourse and multiple intensive care unit admission and 10.58% (N = 414) partners, but the screening for this disease is similar to died during hospitalization. Of the patients who died, that of colorectal cancer, and for this neoplasm, oriented the highest mortality represented by 14.42% was due to to perform screening tests, such as fecal occult blood , transverse colon cancer, and the lowest to 4.85% anus and proctologic examination in patients with risk factors. cancer. Conclusion: The data obtained shows a higher Final considerations:This case is a 59-year-old man who incidence of neoplasms of colorectal and anal region in had never performed screening tests, who suddenly male patients aged between the fifth and sixth decade had proctological symptoms and had less than 30 days of life. Of these, the cancer with the highest incidence of history already diagnosed with advanced anal canal is rectal cancer and in our series, the most lethal was epidermioid carcinoma. The objective of this study is rectal colon cancer (p = 0.0039). to report the need to implement effective screening measures for the asymptomatic population, focusing Contato: Rodrigo Firmino Schirmbeck Moraes more on risk groups. [email protected]
Contato: Rodrigo Firmino Schirmbeck Moraes [email protected] TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL CÓDIGO: 88329
TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL ANÁLISE DA MORBIMORTALIDADE CÓDIGO: 87156 DOS PACIENTES SUBMETIDOS A RETOS- ANALYSIS OF EPIDEMIOLOGICAL PROFILE OF SIGMOIDECTOMIA COM ANASTOMOSE COLORECTAL CANCER, ANAL CANAL AND INTERESFINCTERIANA NO HOSPITAL ARIS- ANUS IN 3,912 HOSPITALIZATIONS IN THE TIDES MALTEZ STATE OF MATO GROSSO Autores: Claudio de Almeida Quadros / Quadros, C. A. / Hospital Aristides Maltez; Manuela Novaes de Andrade Autores: Rodrigo Firmino Schirmbeck Moraes / / Andrade, M.A. / Hospital do Subúrbio; Emerson Luís SCHIRMBECK, RODRIGO F. M. / UNIVAG; Natalia Santana
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Gama Prisco / Prisco, E.L.G / Hospital Aristides Maltez; In this paper will be presented the cases of three Mário Feitosa Falcão / Falcao, M.F / Hospital Aristides patients with inflammatory bowel disease that have Maltez. been treated with biological therapy with Infliximab and Adalimumab, having developed, respectively, Introdução: No Brasil, o câncer colorretal é a 3º non-Hodgkin lymphoma, colorectal carcinoma and mais frequente em homens (8,1%) e 2º em mulheres cholangiocarcinoma after the long-term use of these (9,4%). A retossigmoidectomia com anastomose medications; with that, we sought to demonstrate interesfincteriana tem sido utilizada nos casos de cases of neoplasia developed because of the long- tumores com limite distal de até 1 cm do esfíncter term use of anti-TNF. TNF-alfa presents a fundamental anal, em que o uso de grampeadores não pode role in the immune response, having been associated ser feito, como forma de preservação do esfíncter with carcinogenesis, when supressed, or with anorretal. Objetivo: O presente estudo tem como the contribution to inflammatory diseases, when objetivo avaliar a morbidade e a mortalidade dos dysfunctional. Inflammatory bowel disease has been pacientes submetidos a retossigmoidectomia com pointed as an isolated risk factor for the development anastomose Interesfincteriana no Hospital Aristides of lymphoma, biliary ducts cancer and intestinal cancer. Maltez, em Salvador Bahia. Método: Este é um With anti-TNF treatment, this risk changes in each estudo retrospectivo, de coorte, que foi realizado specific case of neoplasia. This drug acts primarily in the através da análise de 20 prontuários de pacientes mucosa repair, and the response to treatment can get submetidos a retossigmoidectomia com anastomose to 69% of the patients with Chrons disease and to 70% interesfincteriana no período de setembro de 2012 a of the patients with ulcerative rectocolitis in continuous julho de 2018 no Hospital Aristides Maltez. Resultados: treatment with Infliximab. To this moment, long-term A média de idade foi 54,4 anos. 10% eram estádio 0, use consequences have been pointed, such as the 20% eram estádio I, 30% eram estádio II, 30% eram occurrence of opportunistic infections, tuberculosis, estádio III e 10% eram estádio IV. A distância média reactions to infusion and malignancies. Irregular data do limite distal do tumor ao esfíncter anorretal foi de are found surrounding the malignancies, not being 2,48 cm. A morbidade cirúrgica foi de 60%, sendo a completely elucidated. Multiple neoplasias could be complicação cirúrgica mais prevalente a estenose no found, being mainly lymphomas and solid tumours local da anastomose que ocorreu em 8 dos 20 pacientes. of the digestive tract among the most commonly A incontinência fecal ocorreu em 40%, sendo que 1 found. About the development of lymphoma, it has no paciente apresentou incontinência grave necessitando significative alterations when in isolated treatment with de confecção de colostomia. 15% apresentaram recidiva anti-TNF, but with an increased relative risk when in apenas à distância, 5% recidiva local e à distância, combined therapy with immunomodulators of 4.4 (95% e nenhum deles apresentou recidiva local isolada. CI: 3.4-5.4). Although cases of tumour development Conclusão: a maioria dos pacientes apresentou como exist, Biancone et al followed up 404 patients with principais complicações a estenose da anastomose e IBD in treatment with Infliximab through a period of a incontinência anorretal. O limite da margem distal 5 years, and found no increase in malignancies when é fator relevante no resultado oncológico desses compared to the control group. Similar results were pacientes, pois quando a distância do tumor para a found with Lichtenstein et al in a study with 6273 margem distal é menor que 1 cm há maior risco de patients. Some studies have demonstrated, in patients recidiva. Faz-se necessário a avaliação pré-operatória treated with Infliximab, a relative increase in the do tônus do esfincter anorretal no intuito de diminuir a presentation of other inflammatory diseases, such as incidência de incontinência. Wegener`s granulomatosis and rheumatoid arthritis, also demonstrating the presentation of colorectal Contato: Claudio de Almeida Quadros adenocarcinoma and cholangiocarcinoma. This study [email protected];[email protected] presents the cases of three patients with inflammatory bowel disease, having been treated with biological therapy, and that in any given moment have developed TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL neoplasias. CÓDIGO: 87252 Contato: Lucas Camargo Gamba Martins do Amaral CANCER OCURRENCE IN PATIENTS WITH [email protected] INFLAMMATORY BOWEL DISEASE IN TREATMENT WITH ANTI-TNF TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL Autores: Lucas Camargo Gamba Martins Do Amaral CÓDIGO: 87939 / AMARAL, L. C. G. M. / Universidade do Sul de Santa Catarina - UNISUL; Luiz Henrique Locks Correa CECUM-COLONIC JOINT ADENONEUROEN- / CORREA, L. H. L. / Hospital Nossa Senhora da DOCRINE CARCINOMA (MANEC): A CASE Conceição; Cassiano Coral Accordi / ACCORDI, C. C. REPORT / Hospital Nossa Senhora da Conceição; Thamy dos Santos / SANTOS, T. / Hospital Nossa Senhora da Autores: Rejaine / Vilela, R.R. / Universidade Nilton Lins; Conceição; Rayssa Prá Buss / BUSS, R. P. / Hospital Lailson Melgueira Navarro / Navarro, L.M. / UEA; Renata Nossa Senhora da Conceição; Beatriz de Oliveira Kock Maravieski Pareja / Pareja, R.M. / UEA; Sarah Susan / KOCK, B. O. / Universidade do Sul de Santa Catarina Rodrigues Tavares / Tavares, S.S.R. / UFAM; Leandro - UNISUL; Kaiser de Souza Kock / KOCK, K. S. / Hospital Castro Breves / Breves, L.C. / UEA; Angeli Alexandra Nossa Senhora da Conceição. Caro Contreras / Contreras, A.A.C. / UEA; Ana Carolina
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Mota de Sousa / Sousa, A.C.M. / UEA; Geovana Ribeiro Santos / Santos, V. A. / Liga Acadêmica de Oncologia da Silveira / Silveira, G.R. / UEA; Márcio Neves Stefani / do Hospital de Base do Distrito Federal; Laura de Lima Stefani, M.N. / FCECON-AM; Larissa Pessoa de Oliveira / Crivellaro / Crivellaro, L. L. / Liga Acadêmica de Oncologia OIiveira, L.P. / UFAM. do Hospital de Base do Distrito Federal; Kétuny da Silva Oliveira / Oliveira, K. S / Liga Acadêmica de Oncologia Case Report: Patient, TMS, 66 years old male, born do Hospital de Base do Distrito Federal; Bruna da Silva in Boa Vista (RR), from Autazes (AM), smoker, former Feitosa / Feitosa, B. S. / Liga Acadêmica de Oncologia alcoholic and with family history of colorectal neoplasia. do Hospital de Base do Distrito Federal; Bruno José In October 2018, the patient began to experience pain de Queiroz Sarmento / Sarmento, B. J. Q. / Unidade in the right and left iliac fossa, a stabbing pain, without de Cirurgia Oncológica do Instituto Hospital de Base; irradiation, and a physical examination that presented Rodrigo Nascimento Pinheiro / Pinheiro, R. N. / Unidade palpable masses of hardened consistency, moderaly de Cirurgia Oncológica do Instituto Hospital de Base. pain intensity, reports use of Scopolamine and later use of Acetaminophen. Alteration of bowel habit, melena and Patient A.G.V, 70 years old, male, arrives at a public constipation, but without weight loss. Histopathological hospital‘s emergency room with history of weight loss of examination showed colon adenocarcinoma by 12 kilos in the last 6 months. Refers chronic abdominal colonoscopy and the patient underwent total colectomy pain with worsening 3 days ago and condition with ileorectal anastomosis in April 2019. A histological associated with anorexia and vomiting episodes related analysis of the immunohistochemical histological to enterorrhagia. Denies fever of infectious symptoms. specimen indicates two distinct histological types: Both endoscopy and colonoscopy were realized, with mixed adenoneuroendocrine carcinoma (MANEC), in results of presbioesophagus and ulcerative vegetating cecum colonic with subserosas involvement, associated lesion in the right colon and sigmoid, respectively. On with moderately differentiated adenocarcinoma, distal Computed Tomography, a synchronous colonic tumor to the muscularis itself (K9). Free margins. The tumor of right and left colon with no signs of metastasis. The was classified according to the TNM classification as pT3 biopsies revealed adenocarcinoma-like cecum lesion pN0 (MANEC) + pT2 pN0 (Adenocarcinoma). Discussion: with mucinous and signet ring components, and the A colectomy was used to treat various pathologies, sigmoid colon mucosa sample is also compatible with including for synchronous malignant tumors in the well-differentiated and mucinous adenocarcinoma. colon. In general, the most frequent histological type of Patient developed acute obstructive abdomen, being bowels malignant tumor is adenocarcinoma. The aim submitted to total colectomy, ileostomy and cystostomy. of this study is to report the atypical case of a mixed Extensive retroperitoneal adenomegaly was evidenced neuroendocrine adenocarcinoma (MANEC) in cecum- along with peritoneal carcinomatosis. Staging TxLxM1b colonic transition. Currently, MANEC are isolated in due to the presence of locally advanced disease with the same way as neuroendocrine (NECs), with surgical pulmonary metastasis. The adenocarcinoma is the procedures, divided into two sessions: conventional most common type of colorectal cancer. The mucinous operation (as a colectomy, chosen as the treatment subtype, attendant in the patient‘s sigmoidal portion, for the study of this study) and a local resection. There is characterized by extracellular mucin in more than is no standard management strategy so far, due to 50% of the tumor volume, while the cecal segment the rarity of this pathological condition, so aggressive presents signet ring cells, which is usually diagnosed in therapies should be considered as treatments options. more advanced stages, with long symptomatology and Surgical resection is the main indication and should be worse prognosis. From this perspective, the presence followed by adjuvant therapy. Concluding Comments: of a synchronous tumor is ratified, since the possibility The MANECs presented a cecum-colonic transition after of one being metastatic to the other is excluded. colectomy. Because of the scarcity of these cases, there Important factors in therapeutic decision and prognosis must have a better research on it, in order to enhances are: age, presence of comorbidities, clinical status and the diagnosis and the therapeutic approaches. tumor staging. Standard surgical resection aims for distal margin free from neoplastic infiltration, when Contato: Rejaine Ribeiro Vilela there is a safe and wide resection limit in the operative [email protected] part. This study reports a case of a synchronous colon tumor which motivation is the uniqueness of the case due to the presence of two histological variations. TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL CÓDIGO: 87778 Contato: Viviane Alves dos Santos [email protected] COLON SYNCHRONIC ADENOCARCINOMA: CASE REPORT AND REVIEW OF THERAPEUTIC TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL UPDATES CÓDIGO: 86946 Autores: Amanda Guedes Assis Dutra / Dutra, A. G. A. / LAONCO-IHBDF; Mylena Valadares Silva / Silva, M. V. / Liga COLORECTAL CANCER WITH OVARIAN AND Acadêmica de Oncologia do Hospital de Base do Distrito BONE METASTASIS : CASE REPORT Federal; Ana Karoline Mendes Rossetto / Rossetto, A. K. M. / Liga Acadêmica de Oncologia do Hospital de Base Autores: Gustavo Torres Lopes Santos / Santos, G.T.L. do Distrito Federal; Alexandre de Souza Rocha Alcântara / LIGA CONTRA O CANCER - RN; Daniel de Mendoca / Alcântara, A. S. R. / Liga Acadêmica de Oncologia do Brandao / Brandao, D.M. / LIGA CONTRA O CANCER - Hospital de Base do Distrito Federal; Viviane Alves dos RN; Daniele Maria Lopes Pinheiro / Pinheiro, D.M.L /
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Universidade Potiguar; Gabriela Benetti de Grande Estado do Amazonas; Sarah Susan Rodrigues Tavares Santos / Santos, G.B.G / Universidade Potiguar; Ionária / Rodrigues, S.S / Universidade Federal do Amazonas; Carvalho / Carvalho, I. / Universidade Potiguar. Rejaine Ribeiro Vilela / Vilela, R.R / Universidade Nilton Lins; Maxine Aguiar Damasceno / Damasceno, Introduction: Colorectal cancer (RCC) is the third most M.A / Universidade do Estado do Amazonas; Sidney common cancer worldwide. Metastases being the leading Raimundo Chalub / Chalub, S.R / Fundação Centro de cause of cancer-related mortality. RCC advances from Controle de Oncologia do Estado do Amazonas. the primary tumor to neighboring organs or structure, implantation into the peritoneum or intra-abdominal Case Report: Patient C.R.S.A, brown, 40 years old, obese, organs and through the lymphatic and hematogenous born in Manaus - AM, was treated with pain in the left pathways. The main organs involved in metastases flank of the colic type with gradual evolution for 3 years. are the liver (75%), lungs (15%), bones (5%) and central It refers to the presence of palpable mass in the same nervous system (5%). Bone metastasis is rare as is location. Former chronic alcoholic for 20 years, denies ovarian metastasis. Objectives: To discuss the clinical smoking. Reported use of subcutaneous Lipostabil for two presentation, diagnosis and therapeutic management months 5 years ago. Total abdominal Doppler ultrasound of colorectal adenocarcinoma with bone and ovarian was performed and showed a nodular hypoechoic metastasis. Methods: Case report of a patient diagnosed image in the periumbilical area, with irregular borders with colorectal adenocarcinoma and ovarian metastasis and peripheral vascularization. Abdominal and pelvic and subsequent bone metastasis. Case Report: Patient tomography revealed peritoneal expansive formation ECS, 42 years old, has been coming to the cancer surgery in contact with the ileum loop and nodules suggestive department complaining of lower abdominal pain for 1 of pelvic peritoneal implants and affected lymph nodes. month. No findings on physical examination. Evidence He underwent laparotomy for resection of the mass of pelvic mass in left ovary topography. The patient firmly adhered to an epiplon segment, measuring 1,718 underwent exploratory laparotomy that showed right g and measuring 20x19x13 cm. The histopathological adnexal lesion associated with a stenosing and obstructed report showed poorly differentiated neoplasia with areas lesion in recto-sigmoid transition. He underwent of sarcomatous aspect along with areas of necrosis. In hysterectomy with bilateral adnexectomy, retroperitoneal immunohistochemistry, malignant neoplasia of small lymphadenectomy, pelvic lymphadenectomy and solid blocks, small, monomorphic round oval cell nests and Hartman rectosigmoidectomy. Moderately differentiated cords was noted, favoring the diagnosis of Small Round sigmoid adenocarcinoma result, left ovarian and lymph Cell Desmoplastic Tumor (TDPCR). Oncologic PET-CT 60 node metastatic adenocarcinoma, indicating colon tumor days after surgery showed expansive nodules, located as the primary. Pathological staging pT3N1M1. Beginning in vesico-rectal peritoneal reflection, mesenteric lymph of palliative chemotherapy. After 6 months the patient nodes and soft tissue lesions. Resection of metastatic foci begins to report pain in the left knee. PET-Scan suggests evidenced by PET-CT was chosen. Asymptomatic patient, lymphadenopathy in the left pulmonary hilum, poorly remains under clinical observation and outpatient follow- defined bone sclerosis in the left tibia, and amorphous and up every 6 months. Discussion: TDPCR mainly affects irregular tissues in the vaginal dome and nodule between the intra-abdominal cavity and is more common in male the bladder and distal ureter, indicating neoplastic children and young adults. The main form of presentation involvement. Biopsy of tibial lesion showed involvement is multiple nodules adhered to the abdominal surface. of metastatic adenocarcinoma with probable colon origin. It is a rare neoplasm, with just over 100 cases described Discussion and results: RCC is a common cancer, and its in the literature, the main foci of peritoneum, liver and main cause of death is liver and lung metastasis. However, lymphoid tissue metastasis. The diagnosis is made by bone metastasis is a rare site present in only 3.7 - 11% of immunohistochemistry and the prognosis is poor due clinical cases. Adenocarcinoma metastasis to the ovary is to poor response to chemotherapy and radiotherapy also very rare.Conclusion: It is evident that RCC metastases mainly in late diagnoses when the tumor is unresectable, are common, but in the ovaries and bone they are rare unlike the case in which surgical resection was possible. Final comments: It is noted the rarity of the case and the Contato: Gustavo Torres Lopes Santos importance of registering and discussing similar clinics [email protected] in order to standardize drug and surgical treatment protocols, in order to provide targeted therapy and increased survival of patients with quality of life. TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL CÓDIGO: 88314 Contato: Lailson Melgueira Navarro [email protected] DEMOPLASTIC TUMOR OF SMALL ROUND CELLS - A CASE REPORT IN BRAZILIAN TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL NORTHWEST CÓDIGO: 87185 Autores: Lailson Melgueira Navarro / Navarro, L.M / Universidade do Estado do Amazonas; Larissa Pessoa EVALUATION OF SELF-REFERRED QUALITY OF de Oliveira / De Oliveira, L.P / Universidade Federal do LIFE BEFORE THE TREATMENT IN PATIENTS Amazonas; Louise Desiree Sevalho Neves / Neves, L.D.S / WITH COLORECTAL ADENOCARCINOMA IN Universidade do Estado do Amazonas; Angeli Alexandra Caro Contreras / Contreras, A.A.C / Universidade do A CITY FROM WESTERN SANTA CATARINA: Estado do Amazonas; Renata Maravieski Pareja / PRELIMINARY RESULTS Pareja, R.M / Universidade do Estado do Amazonas; Autores: Matheus Pelinski da Silveira / Da Silveira, M. Leandro Castro Breves / Breves, L.C / Universidade do P. / Universidade Federal da Fronteira Sul; João Paulo
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Dal Magro Mocellin / Mocellin, J. P. D. M. / Universidade / Liga Norte Riograndense Contra o Câncer; Andre Luiz Federal da Fronteira Sul; Sarah Franco Vieira de Oliveira Costa e Silva / Silva, A.L.C / UNP; Bruno Pessoa Chacon / Maciel / Maciel, S. F. V. O. / Universidade Federal da Chacon, B.P / UNP; Lourrane Cury Bezerra de Medeiros Fronteira Sul; Andréia Machado Cardoso / Cardoso, A. / Medeiros, L.C.B / UNP. M. / Universidade Federal da Fronteira Sul. Appendix tumors are rare and constitute less than 1% of Introduction: Colorectal cancer (CRC) is defined as intestinal neoplasms. Low-grade appendiceal mucinous malignant neoplasms localized at the colon, rectum and neoplasm (LAMNs) are among the most common of large intestine. It is the third most frequent cancer in the epithelial neoplasms. LAMNs are mucinous tumors that world and the second in number of deaths. Objective: To present a risk of peritoneal dissemination associated analyze quality of life parameters in patients diagnosed with extraperitoneal Pseudomyxoma (EPP). Report a with adenocarcinoma histologic subtype of CRC. case of low-grade cecal appendage mucinous neoplasia. Methods: selection of participants with adenocarcinoma Descriptive case report study. Case Presentation: V.R.T., subtype CRC, without previous treatment for the male, 64-years-old, admitted to the service complaining neoplasia, from 18 to 70 years, with the application of an asymptomatic expansive lesion in the right iliac of the EORTC QLQ-C30 and EORTC QLQ-CR29 quality fossa for two years. On examination, painless palpable of life questionnaires after signature of the Informed mass throughout the right hemiabdomen. Computed Consent Form. The quality of life score is calculated with tomography (CT scan) of the upper abdomen and pelvis the Microsoft Excel 2010 software, following scoring showed a large predominantly cystic lesion in the right procedures of the questionnaires. Results: 14 people hemiabdomen (mucocele of the appendix?), a celiac trunk preliminarily participated in the study, 7 men and 7 fusiform ectasia, observed within its dubious dissection women. The mean (M) of age of the patients is 59 years, flap, without signs of hypoperfusion. He underwent standard deviation (SD) is 11,11 years. The 30 questions resection of the retroperitoneal tumor, right partial from the C30 questionnaire were split into 3 scales adrenalectomy, retroperitoneal lymphadenectomy, and (functional (FS), symptoms (SS) and global quality of life appendectomy. The pathology of the surgical specimen (QL)), while the 29 questions from the CR29 were split revealed low-grade cecal appendage mucinous neoplasm, into functional scale (FS) and symptoms scale (SS). The free margins, and absence of lymph node metastasis. score was calculated and varies from 0 to 100. To FS and Currently, the patient is under follow-up. Discussion: QL, the performance of the patient is better if the score LAMNs typically occurs in patients in their sixth decade is high. About SS, when it gets closer to 0, means that the of life. Although most commonly present with abdominal patient has fewer symptoms from the CRC. The scores pain that clinically mimics acute appendicitis, these were calculated in general form and by sex, M from tumors are often discovered incidentally during research women (MW) and SD from women (SDW), M from men or surgery for another cause. In the case described, due (MM) and SD from men (SDM). In the C30 questionnaire, to the lesion extent, it was possible to investigate the for FS, M was 69.83 and SD was 19.36 (MW= 68.24 and finding and to find out that it was a LAMN. Asymptomatic SDW=17.43; MM=71.42 and SDM=22.42). For SS, M was cases occur mainly in women because they are more 32.73 and SD was 22.43 (MW=29.75 and SDM=18,68). likely to undergo appendectomies during gynecological For QL, M was 61.90 and SD was 25.88 (MW=67.85, surgeries. Appendix mucinous neoplasms may cause SDW=21.74; MM=55.94, SDM=29.93). In the CR29 cystic dilatation of the appendix (mucocele), and the questionnaire, for FS, M was 55.76 and SD was 17.67 rupture of a retrocecal LAMN may result in a mucinous (MW=59.93, SDW=6.21; MM=51.59; SDM=17.49). For collection in the retroperitoneum, the EPP. Due to the SS, M was 26.94 and SD=11.66 (MW=20.40, SDW=14.39; risk of rupture, the treatment consists of surgery. There MM=33.48, SDM=7.91) Conclusion: For FS, patients in are recommendations for more aggressive management, general present values near the reference value, with a such as the right hemicolectomy and removal of all mucoid small difference between men and women. About SS, implants associated with surgical cytoreduction, although some values are close to the reference values, while appendectomy is considered a definitive treatment. Final others present above or below the reference in some considerations:The LAMNs are rare, and their clinical categories, showing that some symptoms are more or significance is the possibility of EPP, a complication less referred. Factors like CRC staging, age mean and associated with a worse prognosis. Thus, the recognition comorbidities may be responsible for the differences. of findings suggestive of neoplasia is fundamental for For QL, the values are close to the reference; however, proper management and better evolution of the disease. there is a significant difference between self-perception of health in women and men (smaller for men). Contato: andre luiz costa e silva [email protected] Contato: Matheus Pelinski da Silveira [email protected] TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL CÓDIGO: 88155 TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL CÓDIGO: 87868 MUCOCELE OF THE APPENDIX AND ULCERATIVE RECTOCOLITIS: UNUSUAL CASE LOW-GRADE MUCINOUS NEOPLASM OF THE REPORT IN RARE ASSOCIATION CECAL APPENDIX: A CASE REPORT Autores: Silvano Cambruzzi / Cambruzzi,S. / Associação Autores: Crislanny Regina Santos da Silva / Silva, C.R.S Hospitalar São José; Alexandre Lorenzini Schlabendorff / Famene; Isa Maryana Araújo Bezerra de Macedo / / Schlabendorff,A.L. / Associação Hospitalar São José; Macedo, I.M.A.B / UNP; George Alexandre Lira / Lira, G.A Fernando Papp / Papp,F. / Associação Hospitalar
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XIV Congresso Brasileiro de Cirurgia Oncológica
São José; Guilherme Wiese Roeder / Roeder,G.W. / Misericórdia de Maceió; Alberson Maylson Ramos da Associação Hospitalar São José; Carina Yumi Takahashi Silva / SILVA, A. M. R / Santa Casa de Misericórdia de / Takahashi,C.Y. / Associação Hospitalar São José; Maceió; Elson Alexandro Cordeiro Folha Filho / FOLHA Vanessa Pillon / Pillon,V. / Associação Hospitalar São FILHO, E. A. C. / Santa Casa de Misericórdia de Maceió; José; Jorge Ribeiro Junior / Ribeiro,J.J. / Associação Gustavo Mendonça Ataide Gomes. / GOMES, G. M. A. / Hospitalar São José. Centro de Ensino Superior de Maceió (CESMAC).
Case description: 35-years-old female, with previous Case Report: A 55-year-old male patient complaining of diagnosis of Ulcerative Rectocolitis (URC) in clinical epigastric pain and weight loss. On physical examination, remission using mesalazine. Negative family history for the patient presented ECOG1, thin, a painful abdomen colorectal cancer. Presented with pain in the lower right in the epigastrium, and a palpable mass. CT of the abdomen and denied rectal bleeding, fever or weight loss. abdomen showed a lesion of 11.2x9.7x8.1cm in the left Physical exam of the abdomen without palpable mass, hypochondrium with contiguous gastric wall and no pain in the right iliac fossa and no significant changes in metastases. Endoscopy with ulcerated lesion in the gastric laboratory tests. Colonoscopy confirmed URC and showed body and adenocarcinoma biopsy. Colonoscopy with extrinsic compression of the cecal wall. In the Computed splenic ulcerous lesion in the colon, of the same gastric Tomography (CT scan), a fluid-filled tubular structure histology, and elevated low rectus lesion, endoscopically was seen in the cecal base, suggesting appendiceal resected, with pathology compatible with neuroendocrine mucocele. The treatment of choice was appendectomy tumor, free margins. Normal tumor markers. The patient and partial tiphlectomy, inicially laparoscopic and with developed with an obstructive condition and submitted open surgery for ressection without rupture of the exploratory laparotomy with findings of massive appendix and there was no evidence of mucine in the obstructive lesion in the splenic angle of the colon with abdominal cavity. The diagnosis of appendiceal mucinous invasion of the gastric wall and tail of the pancreas. cystadenoma was confirmed with microscopic analysis. Multivisceral resection with subtotal colectomy, partial Discussion: Appendiceal mucocele occurs when there gastrectomy and caudal pancreatectomy in monoblock is an abnormal accumulation of mucine, resulting in associated with terminal ileostomy. She presented distention of the appendix. The reported prevalence is satisfactory evolution and was discharged on the 7th day 0,2 0,7% among appendectomies. The symptomatology after surgery. Discussion: Invasive colorectal cancer that is unable to diferentiate benign or neoplastic causes of contiguously affects adjacent structures without distant mucocele. If there is rupture of the appendiceal mucocele, metastasis occurs in 5 to 18% of cases. They are adequately either spontaneously or during surgery, the mucine leak treated with monobloc resection and free margins, since to the abdominal cavity may lead to pseudomyxoma recurrence after such resection is around 18%, while peritonei. There are few case descriptions of mucinous adhesion violation can reach 69%. Limited resection for cystadenoma of the appendix in patients with ulcerative locally invasive tumors results in 5% survival at 5 years, rectocolitis, and its association is still in discussion. Final a low rate compared to extended resection, which has a considerations:Mucocele of the appendix is an unusual 33% survival rate, showing that the case was satisfactorily disease, with low incidence and most often presenting managed to gain survival. In relation to neuroendocrine as an incidental surgical finding. Surgical excision of the rectal tumor is rare and approximately 10% may be appendix without rupture is the treatment of choice, associated with other colonic neoplasia, the treatment of preventing iatrogenic progression to pseudomyxoma superficial lesions is usually endoscopic, as was the case. peritonei. Even without established association between Concluding remarks: Although postoperative morbidity appendiceal mucocele and URC, special attention must is higher, a one-piece approach reduces the incidence of be given to patients with ongoing follow up for URC bleeding and contributes to better outcomes, showing that present with symptoms such as abdominal pain or local recurrence rates, disease-free period, and overall palpable mass. survival similar to cases that do not require multivisceral resection. The case is relevant because it presents invasion Contato: Guilherme Wiese Roeder of structures such as stomach and pancreas, which are [email protected] not common, and because there is a neuroendocrine synchronic tumor in the lower rectum. Multivisceral resection was important for the patient, since there is TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL evidence of longer survival and lower local recurrence. CÓDIGO: 87604 Contato: Tainá Santos Bezerra MULTIVISCERAL RESECTION IN COLON [email protected] CANCER: CASE REPORT
Autores: Amanda Lira dos Santos Leite / LEITE, A. L. S. TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL / Santa Casa de Misericórdia de Maceió ; Tainá Santos CÓDIGO: 87702 Bezerra / BEZERRA, T. S. / Santa Casa de Misericórdia de Maceió; Claudemiro de Castro Meira Neto / MEIRA NETO, PROFILE OF COLON AND RECTAL CANCER C. C. / Santa Casa de Misericórdia de Maceió; Aldo Vieira PATIENTS ATTENDED AT THE HOSPITAL Barros / BARROS, A. V. / Santa Casa de Misericórdia de Maceió; Filipe Augusto Porto Farias de Oliveira / CANCER DOURADOS (MS), BRAZIL IN 2018 OLIVEIRA, F. A. P. F. / Santa Casa de Misericórdia de Autores: Maurílio de Cássio Golineli / GOLINELI, M. de Maceió; Diego Windson de Araújo Silvestre / SILVESTRE, C. / UNIVERSIDADE FEDERAL DA GRANDE DOURADOS; D. W. A. / Santa Casa de Misericórdia de Maceió; Thiago Caio Cezar Esqueapatti Sandrin / SANDRIN, C.C.E. / Yamamoto Amaral / AMARAL, T. Y. / Santa Casa de UNIVERSIDADE FEDERAL DA GRANDE DOURADOS;
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Claudio Germano Teodoro / TEODORO, C.G / Ribeirão Preto da USP; Mateus Rassi Fernandes Ramos UNIVERSIDADE FEDERAL DA GRANDE DOURADOS; / Ramos, M. R. F. / Hospital das Clínicas da Faculdade de Raquel Esther Hermosilla Nunez / HERMOSILLA, R.E.N Medicina de Ribeirão Preto da USP; Matheus Trindade / HOSPITAL UNIVERSITÁRIO DA GRANDE DOURADOS. Bruxelas de Freitas / Freitas, M. T. B. de / Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto O câncer é uma doença grave, de desenvolvimento da USP; Matheus Angerami Marçal / Marçal, M. A. / progressivo, que acomete os indivíduos em todas as Hospital das Clínicas da Faculdade de Medicina de faixas etárias. Estimativas mundiais, segundo OMS Ribeirão Preto da USP; Mario Vinicius Angelete Alvarez são de 10 milhões de casos novos. O câncer colorretal Bernardes / Bernardes, M. V. A. A. / Hospital das aparece como quarto em mortalidade segundo estatística Clínicas da Faculdade de Medicina de Ribeirão Preto mundiais, com números na ordem de 655 mil mortes/ano. da USP; Rogério Serafim Parra / Parra, R. S. / Hospital No Brasil corresponde ao 3º em número de casos novos das Clínicas da Faculdade de Medicina de Ribeirão (excetuando câncer de pele não melanoma), estimativa de Preto da USP; Antonio Balestrim Filho / Balestrim Filho, 36.360 mil novos casos para 2018, a proporção homens A. / Hospital das Clínicas da Faculdade de Medicina de para mulheres, 1:1,1. Reconhece-se que o risco de CCR ao Ribeirão Preto da USP; José Joaquim Ribeiro da Rocha / longo da vida seja de 5%, aumenta com a idade e mais de Rocha, J. J. R. da / Hospital das Clínicas da Faculdade de 90% dos casos acometem pessoas acima dos 50 anos de Medicina de Ribeirão Preto da USP; Omar Féres / Feres, idade. O tabagismo e a obesidade são associados a fatores O. / Hospital das Clínicas da Faculdade de Medicina de de risco para neoplasia maligna colorretal. O objetivo do Ribeirão Preto da USP. estudo é caracterizar o perfil epidemiológico, sexo, idade, fatores de risco, sinais e sintomais iniciais, e aspecto Introduction: although considered as a single anatomopatológico da doença, dentro da população disease, colonic adenocarcinomas have shown distinct atendida no Hospital do Câncer de Dourados, Mato behaviors according to the primary site. Several studies Grosso do Sul, Brasil. A pesquisa descritiva-analítica de have pointed out important behavior differences caráter documental, qualitativa e quantitativa, transversal in colonic adenocarcinomas, however the national e não intervencionista. Os pacientes com diagnóstico de literature is scarce. Objective: to evaluate the impact adenocarcinoma colorretal (total 25) foram atendidos of tumor sidedness on clinical-pathological variables e submetidos a tratamento oncológico no centro de and tumor behavior in a cohort of patients with colon referência no ano de 2018. Os dados colhidos, mostraram cancer undergoing surgical treatment. Method: we uma predominância masculina 1,5:1 feminino (15 H / 10 conducted a retrospective analysis of medical records M), idade média 64,2 anos (29 a 94 anos), fatores de risco of patients undergoing surgery to treat sporadic colon como tabagismo 60% (15) e sobrepeso/obesidade 64% adenocarcinoma. Patients were divided into two (16 contra 9) estão presentes na maioria dos portares de groups: (1) right colon (RC), tumors located between neoplasia colorretal. A principal sintomatologia referida the cecum and splenic flexure and (2) left colon (LC), em ordem decrescente de frequência, dor abdominal tumors located between the descending and sigmoid (84%), alteração hábito intestinal (64%), hematoquezia colon. Clinical-pathological aspects and oncological (44%), emagrecimento (40%) e abdome agudo obstrutivo outcomes were evaluated in the first two years of (8%). O número de linfonodos retirados variou 1 (pós follow-up. Results: among the 237 patients analyzed, neoadjuvância - radioterapia e quimioterapia) a 66 there was no difference between the groups regarding linfonodos. O estadiamento patológico predominante gender, age, body mass index, ASA classification, IIA (48% - 12 pacientes), com 2 pacientes estadio 0 (Tis) serum albumin levels and percentage of advanced e 2 pacientes com estadio IV (metastático). Os dados disease. There was a predominance of the LC group confirmam a maioria dos estudos na literatura mundial, when compared to the RC group, with 141 patients incidência em pacientes com idade avançada > 60 anos, (59.5%) and 96 patients (40.5%), respectively. There os fatores de risco obesidade e tabagismo na maioria, was a higher incidence of anemia in the RC group e o diagnóstico tardio, com doença avançado no (81.2% x 59.6%; p <0.001). Urgent surgery rates (17% x diagnóstico anatomopatológico. A caracterização do perfil 2.1%; p <0.001) and laparoscopic access (21.3% x 4.2%; epidemiológico do paciente oncológico, fornece dados p <0.001) were higher in the LC group, as well as longer que outorgam a elaboração de campanhas de incentivo duration (190min x 167min; p = 0.007) and higher a prevenção, e diagnóstico precoce da neoplasia maligna stoma rates (36.9% x 18.8%; p = 0.004). Regarding colorretal. surgical aspects, the rates of intraoperative accidents, length of stay, readmission rates, reoperation and Contato: Maurílio de Cássio Golineli early death were similar. RC tumors had higher [email protected] lesion rates ≥ 5cm (66.7% x 44.6%; p = 0.001), poorly differentiated (13.5% x 5%; p = 0.03) and with mucinous differentiation (33.3% x 15.6%; p = 0.002). There were TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL no statistical differences between relapse and death CÓDIGO: 88120 rates at 2-year follow-up. Conclusions: in the present study, RC tumors were larger, poorly differentiated PROGNOSTIC DIFFERENCES IN SPORADIC and with more mucinous differentiation, and were COLONIC TUMORS ACCORDING PRIMARY more associated with anemia. Urgent surgery and stoma surgery were more frequent in tumors of the SITE LC. There were no differences in relapse and death Autores: Marley Ribeiro Feitosa / Feitosa, M. R. / Hospital rates at 2-year follow-up. das Clínicas da Faculdade de Medicina de Ribeirão Preto da USP; Josiane Harumi Cihoda Lopes / Lopes, J. H. C. Contato: Mario Vinicius Angelete Alvarez Bernardes / Hospital das Clínicas da Faculdade de Medicina de [email protected]
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XIV Congresso Brasileiro de Cirurgia Oncológica
TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL CÓDIGO: 87964 CÓDIGO: 87938
RESULTS OF THE TREATMENT OF COLOSTOMY ROBOTTIC RESECTION OF STRAIGHT PROLAPSE WITH THE TOTAL INTESTINAL LEYOMIOMA IN YOUNG PATIENT: A CASE RESECTION TECHNIQUE REPORT Autores: Claudio Almeida Quadros / Quadros, C.A. Autores: Guilherme Vaz de Melo Mota / Mota, G.V.M / UNEB, HAM; Thiago Cardoso Matias / Matias, T. C. / / Hospital Felício Rocho; Haylla Haramoto / Haramoto, UNEB; Antonina Campos Silveira Machado / Machado, H. / Hospital Felício Rocho; Fernando Augusto de A. C. S. / UNEB; Luiza dos Santos Menezes / Menezes, Vasconcellos Santos / Santos, F.A.V / Hospital Felício L. S. / UNEB; Daniela Santos Mascarenhas Ribeiro / Rocho; Diego Paim Carvalho Garcia / Garcia, D.P.C. Ribeiro, D. S. M. / UNEB; Luís Claudio Porto Góes / Góes, / Hospital Felício Rocho; Cyntia Ferreira dos Reis / L. C. P. / ; Manuela Novaes de Andrade / Andrade, M. N. Reis, C.F. / Hospital Felício Rocho; Leonardo Quinete / UNEB. Guimarães / Guimarães, L.V. / Hospital Felício Rocho; Felipe Romano Gonçalves Carvalho / Carvalho, F.R.G. / Introduction: Colostomy prolapse is a complication Hospital Felício Rocho; Mariana Sala de Faria e Silva / that causes patients discomfort, making it difficult Silva, M.S.F. / Hospital Felício Rocho; Thiago de Almeida to apply the ostomy bag. Urgent surgical procedure Furtado / Furtado, T.A. / Hospital Felício Rocho; Pablo might be required to treat pain caused by the ostomy Nelson Do Vale Hubner / Hubner, P.L.V. / Hospital prolapse, or treat life-threatening conditions caused Felício Rocho. by ischemia or necrosis of the prolapsed intestinal segment. It may compromise oncological results, Case Presentation J.C.L, female, 21 years old, complaining postponing chemotherapy delivery or radiotherapy of chronic pelvic pain. Propaedeutic examinations treatment. Surgical procedures proposed for the suggested right ovarian mass, and the patient was treatment of this complication are associated referred for laparoscopy. This visualized a solid tumor, with high recurrence rates, are onerous, require exophytic in the anterior wall of the rectum. Magnetic general anesthesia or prolonged hospitalization. resonance imaging of the rectum was then requested This study presents an unpublished surgical with the presence of an expansive lesion in the transition technique that corrects colostomy prolapse with between the superior rectum and the sigmoid colon, the complete resection of the prolapsed intestinal with extrinsic lobulated contours, measuring about segment, maintaining the colostomy without the 6 cm, heterogeneous in appearance, with areas of need of laparotomy, laparoscopy or skin incisions. central necrosis. At colonoscopy, a submucosal lesion After resection of the prolapsed bowel, manual in the superior rectum was visualized, about 15cm from anastomosis reestablishes the ostomy. The procedure the anal margin, and gastrointestinal stromal tumor is performed with epidural anesthetic block, feeding (GIST) or neuroendocrine tumor was interrogated. An interruption of only 8 hours and provides early endoscopic biopsy was performed, with pathological hospital discharge. It is cheap, not requiring use of diagnosis of leiomyoma. The patient then underwent surgical staplers. Provides quick patients return to resection of the lesion and its primary anastomosis usual activities without interruption of the established by robotic access, with good postoperative results. oncological treatments. Objective: To present results Discussion: Rectal leiomyomas are considered rare of an unpublished surgical technique, highlighting its entities and constitute about 0.1% of rectal tumors. technical simplicity, low cost and excellent results. These tumors originate from mucosal smooth muscle Materials and Methods: This study analyses data on fibers or rectal wall muscle fibers, usually occurring 15 surgical procedures performed in 13 patients who in the two distal thirds and with intraluminal growth. presented colostomy prolapse and were treated with Diagnostic modalities include colonoscopy, endoscopic this technique of surgical resection of the prolapsed ultrasound, tomography and magnetic resonance segment and manual anastomosis, between imaging, and rectal echoendoscopy is preferable to January 2016 and July 2018, at Aristides Maltez other methods for local tumor staging. It is important Cancer Hospital, Salvador, Bahia, Brazil. Results: to differentiate the leiomyoma with two entities: GIST, Mean duration of the surgical procedure was 33.57 which is immunohistochemical positive for c-kit (CD117); minutes, average length of the prolapsed intestinal and leiomyosarcoma, with a poor prognosis, with resected segments was 11.96cm, average duration survival rates of 20% to 40% in five years. The treatment of hospitalization was 1.27 days, all patients started of leiomyoma depends on the degree of invasion. eating as they were discharged of the operating room Endoscopic resection can be performed on tumors up and there was no surgical or clinical complication to the mucosal muscle. In deep to submucosal tumors, related to the procedure. There were 02 late relapses surgical resection is considered the treatment of choice. among the 13 patients (15%), these 02 patients were Among the access ways, minimally invasive robotic reoperated with the same technique without further surgery brings the benefits of less postoperative pain, recurrence of the prolapse. Conclusion: It is safe, early recovery of bowel function, shorter hospital stay, cheap and easy surgical technique, without surgical among others. Final comments: Rectal leiomyoma or clinical complications in the studied group, that is a rare clinical condition and should be considered provides lower prolapse relapse rates than other in the differential diagnosis of muscle wall lesions of available techniques. the digestive tract. Its treatment is mostly surgical. Robotic surgery allows complex surgical procedures to Contato: Thiago Cardoso Matias be performed safely in anatomically restricted spaces, [email protected]
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maintaining all the benefits found in minimally invasive TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL surgical procedures. CÓDIGO: 87704
Contato: Haylla Haramoto SYNCHRONIC COLORECTAL CANCER: REPORT [email protected] OF THREE CASES AND COMPARISON WITH THE LITERATURE TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL Autores: Andre Luiz Mezzaroba Pellizzon / Pellizzon, A. L. CÓDIGO: 88143 M. / Santa Casa de Paranavai; Jamile Ferreira Fernandes / FERNANDES, J. F. / Santa Casa de Paranavaí; Taciane SURVIVAL OF PATIENTS WITH COLON CANCER Dalgallo / DALGALLO, T. / Santa Casa de Paranavaí; WHO UNDERWENT CURATIVE SURGERY AT Tiago Mezzaroba Pellizzon / PELLIZZON, T. M. / Santa HOSPITAL NOSSA SENHORA DA CONCEIÇÃO, Casa de Paranavaí; Thiago Tadeu Amancio / AMANCIO, T. T. / Santa Casa de Paranavaí; Carlos Alberto Ferreira PORTO ALEGRE / RS / FERREIRA, C. A. / Santa Casa de Paranavaí; Jaqueline Autores: Muriel Ferreira da Silva / Silva, M. F. / ULBRA; Fernandes Amaro dos Santos / SANTOS, J. F. A. / Santa Luciano Pinto de Carvalho / Carvalho, L. P. / Hospital Casa de Paranavaí; José Arisitides Campelo Cabral / Nossa Senhora da Conceição; Ricardo de Oliveira CABRAL, J. A. C. / Santa Casa de Paranavaí. Barañano / Barañano, R. O. / ULBRA. Introduction: Synchronic cancer is defined as one Introduction: The survival of patients with colorectal or more neoplasms diagnosed in a single patient cancer is directly related to the stage of the disease. simultaneously or within six months of the initial Because they present rare symptoms at an early stage, diagnosis. In the case of colorectal cancer, its incidence most patients are diagnosed late, thus with advanced varies from 2.3 to 4% and is a difficult preoperative disease. As this is a neoplasm of high and increasing diagnosis entity. Objective: To analyze the cases in our incidence worldwide, is necessary to analyze the service in comparison with reports in the literature, appropriate therapy and its effectiveness. Objective: concerning the epidemiological profile as well as To evaluate the survival of patients with stage I, II and III the different ways of diagnosis and presentation of colon cancer who underwent curative surgery at Hospital synchronous colorectal cancer. Method: Retrospective Nossa Senhora da Conceição (HNSC) between 2010 and study with analysis of medical records, and identified 2013. Methods: Cross-sectional retrospective study three patients diagnosed and managed with colon using electronic medical records as a data source. All adenocarcinoma over a 5-year period, and compared patients with stage I, II and III ICD10 C18 who underwent with the literature data. Results: In all three cases, curative intent surgery at the HNSC from 2010 to 2013 synchronous colon adenocarcinoma was identified in all were included in the study. Those who had outpatient women, all under the age of 60 years, disagreeing with follow-up of less than 6 months and patients who died the literature, all with different ways of presentation. due to postoperative complications were excluded. In agreement with the literature, the ascending colon The epidemiological profile, the proposed treatment, was the most common place of involvement, and disease recurrence and overall 5-year survival were adenocarcinoma was the most prevalent histological analyzed. Results: The total study sample consisted of type. None of them were identified only with a 74 patients, with a predominance of females (62.2%). diagnostic method, mainly used colonoscopy and with The average age was 69.2 years. The mean follow-up association tomography and even barium enema. was 62.7 months. Regarding tumor location, 8 (10.8%) Conclusion: The discrepancy of the prevalence in our were located in the cecum, 10 (13.5%) in the ascending cases in relation to the literature, as well as the different colon, 6 (8.1%) in the hepatic flexure, 1 (1.3%) in the diagnostic methods used, and the different range of colon. transverse, 2 (2.7%) in the splenic flexure, 5 (6.8%) clinical presentation among the patients of our service, in the descending colon, 42 (56.8%) in the sigmoid. show the difficulty in identifying patients with possible Regarding TNM staging, 7 (9.5%) patients were stage synchronic colorectal cancers. which may mainly involve I, 37 (50%) stage II and 30 (40.5%) stage III. Among the the management and survival of these patients. surgical treatment, rectosigmoidectomy was the most performed surgery (58.1%). Adjuvant chemotherapy was Contato: André Luiz Mezzaroba Pellizzon performed in 48 patients (64.9%). Of the total number [email protected] of patients in the study, 9 (12.2%) died, 3 due to cancer. The disease recurred in 7 (9.5%) patients, most of them in stage III (57%), with a mortality of 43% (p = 0.035). The TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL median survival time of patients with recurrence of the CÓDIGO: 87910 disease was 62.8 months and those who did not present was 91.1 months (p = 0.008). The overall 5-year survival SYNCHRONOUS COLORECTAL AND RENAL was 89.2%. Conclusion: Recurrence of the disease TUMORS: A RARE ASSOCIATION was a factor associated with increased mortality and consequent reduction in long-term survival of patients Autores: Renata Pereira Fontoura / Fontoura, R.P. / with colon cancer. Overall 5-year survival of HNSC Liga Acadêmica de Oncologia do Hospital de Base do patients was similar to the literature. Distrito Federal; Viviane Alves dos Santos / SANTOS, V. A. / Liga Acadêmica de Oncologia do Hospital de Contato: Muriel Ferreira da Silva Base do Distrito Federal; Mylena Valadares Silva [email protected] / SILVA, M. V. / Liga Acadêmica de Oncologia do Hospital de Base do Distrito Federal; Henrique
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Barbosa de Abreu / Abreu, Henrique Barbosa / Liga TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL Acadêmica de Oncologia do Hospital de Base do CÓDIGO: 88388 Distrito Federal; Beatriz Pires Paes / PAES, B. P. / Liga Acadêmica de Oncologia do Hospital de Base do SYSTEMATIZATION OF NURSING Distrito Federal; Kétuny da Silva Oliveira / Oliveira, K.S ASSISTANCE TO ELDERLY PATIENT DURING / Liga Acadêmica de Oncologia do Hospital de Base do Distrito Federal; Anna Paula de Sousa Silva / SILVA, THE PERIOPERATIVE PERIOD OF A RIGHT A. P. S. / Liga Acadêmica de Oncologia do Hospital de DIRECT HEMICOLECTOMY: REPORT OF THE Base do Distrito Federal; Sérgio Murilo Pereira da EXPERIENCE Silva Filho / Silva Filho, S. M. P. / Liga Acadêmica de Autores: Jamille da Silva Mohamed / Jamille, S. Oncologia do Hospital de Base do Distrito Federal; Mohamed / Universidade Federal Fluminense; Jamille Bruno José de Queiroz Sarmento / Sarmento, B. J. Q. da Silva Mohamed / Jamille, S. Mohamed / Universidade / Liga Acadêmica de Oncologia do Hospital de Base Federal Fluminense; Natacha Brito de Sena Lira / do Distrito Federal; Rodrigo Nascimento Pinheiro Natacha, B. S.Lira / Universidade Federal Fluminense; / Pinheiro, R. N. / Liga Acadêmica de Oncologia do Fatima Helena Do Espirírito Santo / Fátima, H. E. Santo Hospital de Base do Distrito Federal. / Universidade Federal Fluminense; Cristhian Antonio Brezolin / Cristhian, A. Brezolin / Universidade Federal Case Presentation: Woman, 49 years old, obese, Fluminense. hypertensive, complained of low back pain in right renal topography for 3 months, showing a solid lesion Introduction:Nursing care from the perspective of a to the images and indicated radical nephrectomy. She perioperative Nursing Care Systematization supports returns to the hospital with abdominal pain for 1 week, the creation a the care plan, implementation of located in right upper quadrant, in colic, associated interventions and patients assessment. Objectives:To with abdominal distension, nausea and vomit. On describe the stages of the Nursing Care Systematization physical examination, palpable mass on the right flank, to an elderly patient during the perioperative of fibroelastic consistency, approximately 6cm in length, a right hemicolectomy.Method: Report from the with no signs of peritonitis. Finding of obstructive experience at the Antonio Pedro University Hospital. lesion in hepatic flexure of the colon, insurmountable A 72-year-old patient with hypertension on her 8th to colonoscopy. Directed to the surgical treatment day of hospitalization was diagnosed with malignant and performed right hemicolectomy and right colon cancer, with a proposed surgery of right radical nephrectomy. Discussion: Tumors are said hemicolectomy.Data collection and clinical evaluation, to be synchronic when they present simultaneously from 05/21/2018 to 05/24/2018. Results: There was with the diagnosis, with a maximum interval of evidence of pain in the right hypochondria, previous 6 months, ruling out the possibility of contiguity surgery of left hemicolectomy. Flaccid abdomen and lesions (metastasis, invasion or recurrence of the surgical scar. In the perioperative period, NANDA-I first), as well as malignant and distinct histological nursing diagnoses evidenced with the proposed types. Colorectal cancer is the most common of the NIC nursing interventions:PREOPERATIVE:A) Risk gastrointestinal tract, with adenocarcinoma being of impaired cardiovascular function, related to the most frequent histopathological type, usually hypertension and age. Interventions are to monitor associated with hereditary syndromes. Signs and blood pressure, pulse and breathing pattern; B)Risk symptoms of alertness should be valued. Renal cell of falling, related to the use of antihypertensive drugs, carcinoma comprises 1 to 3% of visceral neoplasms, age, and change in blood glucose level, having as being the most lethal of urological cancers; the interventions to monitor vital signs.TRANSOPERATIVE: most common histologic subtype is clear cell C)Risk of injury due to perioperative positioning, carcinoma. Renal lesions are usually asymptomatic related to immobilization and disorders resulting and impalpable until the more advanced stages of from anesthesia, having as intervention to monitor for the disease, in addition to being diagnosed, in most sources of pressure and friction; skin monitoring. D) cases, incidentally. Final considerations:Despite the Risk of bleeding associated with te treatment regimen high prevalence of both neoplasms individually, the (surgery), having as intervention to monitor the amount concomitance of primary tumors developing in the and cause of blood loss; provide availability of blood colon and kidney is rarely described. It has a poorly products or whole blood for transfusion, if necessary. E) defined cause and is quite complex, multifactorial. Risk of infection associated with the invasive procedure The main treatment is R0 surgical resection. The (surgery), having as interventions to use antibiotics; prognosis of the disease, in general, depends on the Check sterilization indicators, limit and control traffic. F) staging, the cell type, the cell differentiation and the Risk of perioperative hypothermia associated with the surgeon factor (R0 surgery capacity). The uncommon surgical procedure, having as interventions to adjust the association of these neoplasms reaffirms the need temperature; Minimize patient exposure during surgical for early access to the specialized team, able to preparation and procedure. POSTOPERATIVE: G)Risk of investigate and treat patients with diverse neoplasms infection with interventions to inspect the incision site quickly and efficiently. for redness, edema, signs of dehiscence or evisceration; Apply proper bandage to protect the incision.H)Risk of Contato: Renata Pereira Fontoura falling, with the intervention of monitoring vital signs [email protected] before, during and after activities. I)Contamination risk,
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having as intervention:Identification of safety risks in Although it has a longer operative time, it is related the environment; Conclusion: The nurse is essential in to the decreased hospitalization time and the relative patient recovery, offering safe and quality care. lower morbidity, as in the reported case, in which the patient presented rapid recovery without complications. Contato: Jamille da Silva Mohamed Final considerations:The proctocolectomies are [email protected] laparoscopic procedures with high complexity and despite increasing the surgical time, when well performed, contribute to lower morbidity. After TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL colectomy and ileorectal anastomosis, rectal cancer can CÓDIGO: 88008 still occur in 12-29% of patients. Therefore, an annual examination of patients with preserved rectum it is TOTAL COLECTOMY BY VIDEOLAPAROSCOPY recommended. FOR TREATMENT OF DIFFUSE INTESTINAL Contato: Amanda Barbetto Medeiros Torres POLYPOSIS: A CASE REPORT [email protected] Autores: Amanda Barbetto Medeiros Torres / Torres, A. B. M. / Universidade Potiguar; George Alexandre Lira / Lira, G. A. / Liga Norte Riograndense Contra o Câncer; TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL Francimar Kétsia Serra de Araújo / Araújo, F. K. S. / Liga CÓDIGO: 87657 Norte Riograndense Contra o Câncer; André Luiz Costa e Silva / Silva, A. L. C. / Universidade Federal do Rio Grande TREATMENT OF COLORECTAL CANCER: do Norte; Barbara Paulo Cavalcante / Cavalcante, B. P. / PREEMPTIVE PROTECTIVE COLOSTOMY Universidade Potiguar; Marina Fernandes / Fernandes, REDUCES SURGICAL MORTALITY AND M. / Universidade Potiguar; Juliana Maria Caetano Nogueira / Nogueira, J. M. C. / Universidade Potiguar; REOPERATIONS Víctor José Negreiros de Sá Rosado / Rosado. V. J. N. S. Autores: Luiza Mesquita Barbosa / Barbosa, L.M. / / Universidade Potiguar; Renata Beatriz Bessa Teixeira Hospital Erasto Gaertner; Ewerson Luiz Cavalcanti / Teixeira, R. B. B. / Universidade Potiguar; Pedro de Silva / Silva, E.L.C. / Hospital Erasto Gaertner; Marcelo Albuquerque Mafaldo / Mafaldo, P. A. / Universidade Tsuyoshi Yamane / Yamane, M.T. / Hospital Erasto Potiguar. Gaertner; Alisson Carvalho de Freitas / Freitas, A.C. / Hospital Erasto Gaertner; Jean Borges Curimbaba / Case Presentation: F.M.S., male, 50-years-old, Curimbaba, J.B. / Hospital Erasto Gaertner; Raphaella admitted with abdominal pain and rectal bleeding Ferreira / Ferreira, R. / Hospital Erasto Gaertner; Phillipe for two months, associated with a change in bowel Abreu / Abreu, P. / Hospital Erasto Gaertner; Flavio habits and weight loss. He denied comorbidities Daniel Saavedra Tomasich / Tomasich, F.D.S. / Hospital and previous surgeries. On physical examination, an Erasto Gaertner; Isabela Presse Donasan / Donasan, I.P. absence of lymph node enlargement and abdomen / Hospital Erasto Gaertner. without changes. Brought colonoscopy showing a vegetative lesion in rectosigmoid and diffuse intestinal Summary Objectives: Rectosigmoidectomy and left polyps, the biopsy revealed little differentiated colectomy are procedures widely used in the treatment adenocarcinoma, suggesting the diagnosis of familial of colorectal cancer. The manufacture of protective adenomatous polyposis. Preoperative abdominal and stoma is a controversial subject in the literature. We pelvic computed tomography were performed, which present a series of reference services in oncology in showed thickening of the sigmoid colon walls with southern Brazil, comparatively analyzing the outcome corresponding mesocolon densification associated of cases in relation to the presence or absence of with satellite lymph nodes in the mesocolon and protective colostomy. Methods: A retrospective retroperitoneum, compatible with underlying disease, descriptive comparative study. Patients submitted to and a single hepatic nodule in segment III, suggestive rectosigmoidectomies/left collections in the period from of secondary implantation. It was accomplished total September 2009 to December 2015 at Hospital Erasto proctocolectomy with omentectomy, enterectomy, Gaertner de Curitiba-PR were included. A comparative retroperitoneal lymphadenectomy, enteroanastomosis, analysis was performed between the groups of patients low enterorectal anastomosis, and third segment according to whether or not protective colostomy was metastasectomy. At first, performed by laparoscopy performed. Statistical analyses were performed with and then converted to conventional for removal of the the support of the SPSS 23.0 and STATA 15 programs, piece, the anastomosis, and then the metastasectomy. p<0.05 being considered statistically significant. The postoperative was uneventful. Currently, awaiting Results: We performed 355 rectosigmoidectomies/left pathology. Discussion: FAP is a disease characterized collections for colorectal cancer, 136 (38.3%) without by hundreds to thousands of intestinal polyps of protective stoma and 219 (61.7%) with stoma. The autosomal dominant genetic transmission. Multiple anesthetic ASA risk was significantly higher in the group polyps usually found at age 16, and colorectal cancer of patients with protective stoma. The production of (CRC) appears at around 39 years of age, with a risk the stoma did not add time to the surgical procedure. of 90% up to 70 years if prophylactic colectomy not Severe complications (Clavien-Dindo 3-4-5) occurred in performed. The predominant histological type of CRC is 84 (23.7%) of all patients, 61 (27.9%) with stoma and adenocarcinoma, as in the case above. In the treatment 23 (16.9%) without stomata (p=0.01). There was no of CRC, evidenced in the literature that the laparoscopic significant difference in the rate of reoperation and approach is as safe and effective as the laparotomy. surgical mortality between the groups. Laparoscopic
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surgery was associated with a smaller number of M. V. S. / Universidade Estadual do Maranhão; Vitória stomata. The length of hospital stay was no different Barros Gomes / Barros, V. G. / Universidade Estadual between the groups, but ICU stay was significantly do Maranhão; Sheywe Arnaldo Mendes / Arnaldo, S. longer in the group of patients with protective stoma. M. / Universidade Estadual do Maranhão; Raira Maria Morais de Sousa / Morais, R. M. S. / Universidade Contato: Luiza Mesquita Barbosa Estadual do Maranhão; Thiago Paiva de Sousa / Paiva, [email protected] T. S. / Universidade Estadual do Maranhão; Amanda Sthefeny Santana Rocha / Santana, A. S. R. / Universidade Estadual do Maranhão. TEMÁRIO: TUMORES COLORETAIS E CANAL ANAL CÓDIGO: 88034 Case Report: A 44-year-old female presented with a left cervical mass and thyroid nodules without TROMBOSE DE VEIA PORTA PÓS MUCOSEC- follow-up since 2014. She had a past medical history TOMIA DE RETO DISTAL EM PACIENTE COM of papillary thyroid carcinoma evidenced by fine ADENOCARCINOMA INVASOR DE RETO: UM needle aspiration biopsy (FNA) of the cervical mass performed 6 years ago, without treatment. On physical RELATO DE CASO examination, left cervical lymphadenopaty, fibroelastic Autores: Renan Philippe Souza Pires / Pires, R. P. S. / in consistency, mobile, non-tender and measuring Hospital das Clínicas Doutor Mário Ribeiro; Guilherme 4,4 x 1,5 cm in size. New FNA results revealed cellular Veloso / Veloso, G. / Faculdades Unidas do Norte de atypia and presence of microcalcifications. Computed Minas; Virginia Sousa Brito / Brito, V. S. / Hospital das tomography (CT) of the neck showed atypical lymph Clínicas Doutor Mário Ribeiro; Guilherme Braz Pinto / node enlargement suggestive of a neoplastic process Pinto, G. B. / Hospital das Clínicas Doutor Mário Ribeiro; with microcalcifications occupying levels II to IV on the left. Cervical ultrasonography (USG) revealed small A trombose de veia porta (TVPo) se caracteriza por uma thyroid, right lobe nodule measuring 1.2 x 0.9 x 0.9 obstrução completa ou parcial do fluxo sanguíneo na cm TIRADS 4 and left lobe nodule measuring 1 x 0.5 veia porta secundário à presença de um coágulo na luz x 0.7 cm TIRADS 4. Given the data, the patient was do vaso. A grande maioria dos pacientes é diagnosticada submitted to total thyroidectomy with central neck com achados em exames de imagem. Os sintomas dissection and left posterolateral neck dissection. clínicos podem variar desde ausência de sintomas Anatomopathological examination of the surgical até hemorragia digestiva alta. A escassa experiência specimen revealed a colloid goiter without atypias, nesses casos representa um dilema na abordagem with angiofollicular lymphoid hyperplasia, suggesting desses pacientes e, portanto, a grande maioria dos diagnostic hypotheses of Lymphoma and Castleman‘s autores opta por seguimento rigoroso e a intervenção é disease. Immunohistochemical examination concluded indicada apenas para os pacientes sintomáticos. Neste the diagnosis of Castleman‘s disease. The patient trabalho, descrevemos o relato do caso de um paciente is in the sixth postoperative month following up. do sexo masculino com trombose aguda de veia porta Discussion: Castleman‘s disease (CD) or giant lymph após ser submetido à mucosectomia do reto distal node hyperplasia is a rare benign lymphoproliferative decorrente de um adenocarcinoma de reto. O paciente disorder of unknown etiology. Most tumors are located foi submetido à retirada da lesão por piecemeal com in the abdomen or mediastinum, with rare peripheral ressecção macroscópica completa. O resultado do involvement (10% to 15%). The non-specificity of the anatomopatológico evidenciou pólipo viloso com patient‘s clinical presentation of the case in point, displasia de alto grau e adenocarcinoma invasor G1 with a left-sided cervical mass, absence of systemic sem infiltração vascular ou linfática, restrito a muscular symptoms, normal laboratory tests and previous da mucosa. No desfecho, o paciente apresentou diagnosis of papillary thyroid carcinoma, led to the evidências tomográficas de recanalização total das initial diagnostic hypothesis of lymph node metastatic veias porta e mesentérica superior. disease. Immunohistochemistry demonstrated an exuberant CD23 follicular dendritic cell network, Contato: Renan Philippe Souza Pires confirming the patient‘s Castleman disease. Comments: [email protected] This case report proposes the inclusion of Castleman‘s disease in the differential diagnosis of cervical masses.
TEMÁRIO: TUMORES DE CABEÇA E PESCOÇO Contato: Perla da Rocha Machado CÓDIGO: 87118 [email protected]
CASTLEMAN‘S DISEASE MIMICKING META- TEMÁRIO: TUMORES DE CABEÇA E PESCOÇO STATIC PAPILLARY THYROID CARCINOMA: CÓDIGO: 88311 CASE REPORT Autores: Perla da Rocha Machado / Rocha, P. M. / CORRELATION BETWEEN PREOPERATIVE Universidade Estadual do Maranhão; Márcio Jackson FINE NEEDLE BIOPSY (FNA) AND PATHOLOGY de Souza Barreto / Souza, M. J. B. / Universidade REPORT FOR THYROID NODULES: A PROSPECT Estadual do Maranhão; Thyago Carvalho Resende / STUDY Carvalho, T. R. / Universidade Estadual do Maranhão; Isabelle Santos Palmeira / Santos, I. P. / Universidade Autores: Francisco Araujo Dias / Dias, F. A. / Instituto Estadual do Maranhão; Maisa Vitória de Lima Sá / Lima, do Câncer Dr Arnaldo Vieira de Carvalho; Rafael de
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Cicco / Cicco, R. / Instituto do Câncer Dr Arnaldo Vieira orbital region approximately 01 year, with insidious de Carvalho; Fernanda Denise Alves Dias / Dias, F. D. evolution, causing pain and functional loss of the left A. / Instituto do Câncer Dr Arnaldo Vieira de Carvalho; eye. On physical Examination: ECOG 1, presence of Filipe Lamounier de Barros Guerra / Guerra, F. L. B. / hyperemic tumor lesion affecting the entire left orbit, Instituto do Câncer Dr Arnaldo Vieira de Carvalho; ulceration of the upper eyelid, edema and impossibility Marcelo Soares Schalk / Schalk, M. S. / Instituto do of active or passive opening of the eye, without signs Câncer Dr Arnaldo Vieira de Carvalho; Anna Carolina of invasion of adjacent structures. Contralateral orbit Novais Costa / Costa, A. C. N. / Instituto do Câncer Dr without alterations. The CT of the orbit and the sinuses Arnaldo Vieira de Carvalho; Caroline Molina Maziviero evidenced massive expansive solid formation, affecting / Maziviero, C. M. / Universidade de Mogi das Cruzes; the intra and Extra-conals regions, determining Luccas Rodrigues de Araujo Solitto / Solitto, L. R. A. / compression with the irregularity of the eyeball, involving Universidade de Mogi das Cruzes; Ana Paula da Silva extrinsic muscles and distal portion of the optic nerve, Dias / Dias, A. P. S. / Universidade de Mogi das Cruzes; with no signs of Intracranial extension. No regional lymph Bianca Valezin Bretas / Bretas, B. V. / Universidade de node exansion She underwent exenteration of the left Mogi das Cruzes. orbit, with intraoperative finding of invasion of adjacent bony structures, and enlargement was performed Introduction: The Bethesda system for thyroid cytology with resection of frontal sinus fragment, ceiling of the was created in 2007, to categorize, evaluate and estimate orbit, zygomatic arch and left maxillary sinus, with the risk of thyroid cancer. Furthermore, the estimated rotation of Frontal myocutaneous flap. Free margins cancer risk, according to recent literature, is 1 to 4% for proven by freezing biopsy. The Histopathologic report Bethesda I, 0 to 3% for Bethesda II, 5 to 15% for Bethesda confirmed a moderately differentiated squamous cell III, 15 to 30% for Bethesda IV, 60 to 70% for Bethesda carcinoma (SCC). Discussion: Orbit Exenteration is one V, and 97 to 99% cancer risk for nodules classified of the most disfiguring procedures among ophthalmic as Bethesda VI. However, we observe higher rates of surgeries, and is generally indicated for local control carcinoma in patients classified as Bethesda III and IV. of malignant tumors. Among the neoplasms, basal cell Objective: To correlate the results of cytopathological carcinoma is the most common (90%), followed by SCC. findings with histological reports. Methods: Prospective Kato et al. observed an average survival rate in one year study at Instituto de Cancer Dr Arnaldo from August 2014 of 70% and this value was increased to 58.3% in three to January 2019, with 604 patients enrolled. Inclusion years. SCC has metastatic potential mainly for cervical criteria for surgical treatment included: patients classified lymph nodes. Conclusion: Although mutilating radical as Bethesda III, IV, V or VI, or thyroid nodules larger than exenteration of the orbit represents a good option, 3 cm, regardless of the FNA results. Fisher‘s test and as feasible, to control the symptoms, with impact on Pearson‘s chi squared test were performed to assess the quality of life, and the conviction of curative treatment. dependence between the variables and Spearman‘s test to assess the correlation between the cytological and Contato: Alberson Maylson Ramos da Silva pathological reports. Results: In our cohort, 360 patients [email protected] were diagnosed as papillary carcinoma. The correlation between FNA and histopathological findings was 0% for Bethesda I, 20.6% for classification II, 34.7% for Bethesda TEMÁRIO: TUMORES DE CABEÇA E PESCOÇO III, 39.8% for classification IV, 71.4% for classification V CÓDIGO: 88274 and 89, 3% for Bethesda VI (p <0.01). Conclusions: The risk of malignancy in cases with FNA Bethesda I, II, V and ORAL SQUAMOUS CELL CARCINOMA WITH VI is similar to recent literature. However, we observed a COMPLETE TUMOR RESECTION: A CASE higher malignancy rate in cases with Bethesda III and IV REPORT cytology. Autores: Camila Pereira Muniz / Muniz, C. P. / Hospital Contato: Fernanda Denise Alves Dias Geral de Cuiabá (HG); Mikaella Dal Piva / Dal Piva, M. [email protected] / Hospital Geral de Cuiabá (HG); Kamilla Maciel Costa Sales / Sales, K. M. C. / Hospital Geral de Cuiabá (HG); Cindi Daniele Oliveira de Mello / Mello, C. D. O. / Hospital TEMÁRIO: TUMORES DE CABEÇA E PESCOÇO Geral de Cuiabá (HG); Tabatha Priscila Gomes Felix / CÓDIGO: 87776 Felix, T. P. G. / Hospital Geral de Cuiabá (HG); Gabrielly Menusi / Menusi, G. / Hospital Geral de Cuiabá (HG); EXTENDED RADICAL EXENTERATION OF LEFT Isabel Cristina Lima da Cruz / Cruz, I. C. L. / Hospital ORBIT: CASE REPORT OF A REFERRAL SERVICE Geral de Cuiabá (HG); Jessica Proença Derze / Derze, J. P. / Hospital Geral de Cuiabá (HG); Rodolfo Edson de IN ONCOLOGICAL SURGERY OF MACEIÓ Franco Pimentel / Pimentel, R. E. F. / Hospital Geral de Autores: Alberson Maylson Ramos da Silva / Silva, A.M.R Cuiabá (HG). / Santa Casa de Misericordia de Maceió; Tamires Santos Fraga / / ; Oscar Cavalcante Ferro Neto / / ; Frederico Case Presentation: A 75-years-old male, with a past Theobaldo Ramos Rocha / / ; Aldo Vieira Barros / / ; medical history of hypertension, past alcohol intake Amanda Lira dos Santos Leite / / ; Diego Windson de Araújo and past smoking history for 32 years (pack cigarette Silvestre, / / ; Tainá Santos Bezerra / / ; Thiago Yamamoto plus straw cigarette), admitted at hospital in december Amaral / / ; Elson Alexandro Cordeiro Folha Filho. 2018 presented aphthous, painless and small lesions on the left lower gum. These lesions will evoluated as a Case Presentation: Male Patient, 41 years old, smoker, progressively increasing of size as well became painful with no comorbidities, p complaing of lesion in the left and itchy, compromising the action to eating (loss
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weight of 6 kg ) and speech. The neck tomography Female patient, 56 years old, smoker for 20 years at may 2019 showed a wide soft tissue lesion of the (4 cigarettes / day), reports onset of nodule in left side mouth, adjacent to the alveolar processes of submandibular region with local progressive increase the same side on the mandible. The histopathological for 6 years. On physical examination: presence of report basead from biopsy characterized it an invasive hardened nodule in the right parotid region, adhered squamous cell carcinoma. The physical examination to deep planes, approximately 3 x 4cm, without revealed left lower gum lesion without compromising alterations of the adjacent skin and local fluogistic the floor of the mouth, jaw angle, tongue and lymph signs. At ultrasound: solid, hypoechogenic nodule node chains. All this findings opened the possibility of with regular right parotid contour measuring 3.4 x complete resection, and the patient was underwent 2.8 cm, normal thyroid and absence of cervical lymph to a partial left mandibulectomy with closure Z node enlargement. The puncture aspirated by a fine skin flap (zetaplasty) by oncology surgery team. right parotid needle presented a cytomorphological Patient remained infusion of diet by nasoenteral pattern with characteristics of pleomorphic adenoma. tube. The recovery period it was followed up by the Patient underwent right superficial parathyroidectomy buccomaxillofacial surgery team that that sugested with conservation of the facial nerve, which showed a about the possibility of reconstructive surgery. tumor of fibroelastic consistency occupying the upper Therefore, at the 14th postoperative period a well- lobe of the parotid gland. Patient evolved without successful partial mandibular reconstruction with postoperative complications and is hospitalized under closure of the skin flap was performed by the oral and observation. Pleomorphic adenoma refers to a benign maxillofacial surgery teams. The anatomopathological neoplasm that covers the salivary glands, parotid gland report of surgical speciment at July 2019 presented (60% to 70%). It is an encapsulated tumor, circumscribed moderately differentiated squamous cell carcinoma, and with histological diversity. It is a pathology most with absence at safety margin neoplasia (bone, skin, prevalent in women between the fourth and fifth gingiva and soft tissues). Discussion: Oral cancer decade of life. Parotid superficial lobe involvement is one of the ten most common cancers in Brazilian (90%), slow and unilateral growth. This report aims population and squamous cell carcinoma is the most to report a case of superficial parathyroidectomy due common among males with the ages of fifth and sixth to a parotid tumor. Clinically, the parotid tumor is decade of life. Smoking pratice is one of the most mobile, of hardened consistency and with well-defined prevalent risk factors to this kind of cancer. Although margins. The diagnosis is clinical and the correct the disease occurs in an easily accessible anatomical hypothesis is 92% when performed in conjunction with site, in most part of cases is diagnosed in the late the fine needle aspiration puncture. Imaging exams stages, requiring more aggressive treatment. The will delimit and determine the size and type of lesion. convencional treatment at these cases is by surgery, The gold standard treatment for tumors in the parotid radiotherapy or both. However, becouse of late gland superficial lobe, mobile and smaller than 4 cm is diagnosis make the curative surgery troublesome superficial parotidectomy, an operation that consists or even impossible to occur. Final comments: The of surgical excision with removal of the nodular lesion histopathological confirmation of invasive squamous without exposure of the capsule and with safety cell carcinoma was an outstanding feature to drive margin, with the objective. to prevent relapses of the surgical treatment with complete resection of the pleomorphic adenoma. Possible complications of lesion and well-successfully reconstructive surgery. treatment include: facial nerve dysfunction and Frey‘s syndrome. Finally, this cancer has a 95% chance of cure Contato: Mikaella Dal Piva when the therapeutic approach is performed correctly. [email protected] Contato: Daniel Mendonça de Almeida [email protected] TEMÁRIO: TUMORES DE CABEÇA E PESCOÇO CÓDIGO: 87935 TEMÁRIO: TUMORES DE CABEÇA E PESCOÇO PLEOMORPHIC PAROTID ADENOMA: A CASE CÓDIGO: 88102 REPORT SENTINEL LYMPH NODE BIOPSY FOR HEAD Autores: Bruna da Silva Feitosa / Feitosa, B. S. / AND NECK MELANOMA - CASE SERIES Universidade Católica de Brasília; Nathana Do Prado Oliveira / Oliveira, N.do P. / Universidade Católica de SHOWING SAFETY AND EFFICIENCY OF THE Brasília; Ana Luiza Dias Moreira / Moreira, A. L. D. / METHOD Universidade Católica de Brasília; Aline de Amorim Autores: Guilherme Souza / Souza, G. / Oncad; Milhem Duarte / Duarte, A. de. A. / Hospital de Regional de J M Kansaon / Kansaon, M.J.M. / Oncad; Otto Muller / Ceilândia; Pedro Henrique de Oliveira / Oliveira, P. H. Muller, O. / Oncad; Fernando Augusto de Vasconcellos / Universidade Católica de Brasília; Laércio Soares Santos / Santos, F.A.V. / Oncad; Ana Paula Drummond- Gomes Filho / Filho, L. S. G. / Centro Universitário do lage / Drummond-Lage, A.P. / Faculdade Ciências Planalto Central Aparecido dos Santos; Camille de Souza Médicas de Minas Gerais; Alberto Julius Alves Wainstein Carvalho / Carvalho, C. de .S. / Universidade Católica de / Wainstein, A.J.A. / Oncad. Brasília; Francisco Edson Rocha / Rocha, F. E. / Hospital de Regional de Ceilândia; Daniel Mendonça de Almeida Introduction: Melanoma is a malignant neoplasm with / Almeida,D.M. / Universidade Federal do Pará; Pedro high rates of lymph node spread. Sentinel lymph node Henrique Alves Mendes / Mendes, P. H. A. / Hospital de biopsy (SLNB) is well established in staging, especially Regional de Ceilândia.
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in limb and chest involvement. Head and neck region in the right previous cervical region, beginning at the has always been a challenge for surgeons, whether due height of the mandible angle and running below to the to anatomical complexity or the abundant distribution height of the seventh cervical vertex measuring about of lymphatic drainage. This amplifies the inaccuracy 66x67x82 mm. Well demilitated, there is extension of the exact sentinel node location. In this approach for oropharinge with compression and displacement a myth that contraindicated SLNB in this topography of the air column presenting large contact with the was developed. Objective: Describe a case series of right common caroid and the revolution of the bulb patients with head and neck melanoma submitted to with right internal jugular displacement. After proper SLNB, by an oncologic surgery team, in the context preparation and assessment of surgical risk that has of supplementary health. Method: A retrospective not been prohibited to surgical approach, the patient analysis of medical records, scintigraphies, and was subject to extensive right cervicotomy extense with pathological examinations was performed. The cervical vessel control and large surgical resection of the collected data were gender, age, histopathological large cervical lymphedenectomy pasta, where current diagnosis and location of the primary lesion, Breslow without intercurrence and with great post-operative and Clark, number of sentinel lymph nodes, number recovery.Results: Despite the counter-indication to the and topography of dissected lymph nodes in gamma- surgical approach due to the patientsage reported by the probe guided surgery, and number of lymph nodes services sought in the city of origin. The patient obtained positive for metastases. Results: Six patients aged high on the second preoperative day in great conditions 24 to 89 years were included, five women. The most and so keep up your ambulatory return occurred in two common primary site was the eye conjunctiva (50%), weeks when skin points were removed and it was not scalp (40%) and face (10%). Three patients had primary observing any of the procedure. Anatomopathological site biopsies such as invasive conjunctival melanoma, study shows mixed maligna neoplasia presenting two Spitz melanoma, and one superficial spreading expansive, non infiltrative growth, with necrosis and melanoma. Excluding conjunctival melanomas, Breslow hypercellularity, without evidence of neoplasia at was 1.2mm, 1.8mm, and 4.0mm. At scintigraphy, the surgical limits at examined courts. Study of isolated number of lymph nodes was one to four, and dissected lymphonodes shown only chronic lymphenenite. in the SLNB one to six, all negative for metastasis. The Conclusion: Fine needle aspiration many times you location of lymph nodes, according to scintigraphy, was cannot have an accurate diagnosis before the definitive axillary, parotid, and neck level I and IV simultaneously. treatment. Standard treatment for these neoplasms Conclusion: SLNB is possible even in the exact location is surgical, always carried out following oncological of the head and neck regions during surgery of the precedures of resection with proper margins and repair same lymph node that was marked on scintigraphy. As of surgical defect in the same operating act. in neither case did surgical complications or injuries to anatomical structures occur, these preliminary results Contato: Ivan Tadeu de Mendonça Junior suggest low morbidity. Lymphatic drainage is extensive [email protected] in this surgical area, and SLNB enriches the staging of melanoma. TEMÁRIO: TUMORES DE CABEÇA E PESCOÇO Contato: Milhem J M Kansaon CÓDIGO: 86962 [email protected] TUMOR TRABECULAR HIALINIZANTE DE TIREÓIDE, RELATO DE CASO EM HOSPITAL DE TEMÁRIO: TUMORES DE CABEÇA E PESCOÇO CÓDIGO: 87041 REFERÊNCIA ONCOLÓGICA NA AMAZÔNIA Autores: Rodrigo Luiz Ferreira Santos / RODRIGO L. TREATMENT OF SUBMANDIBULAR TUMOR IN F. SANTOS / HOSPITAL OPHIR LOYOLA; Lorena L. M. THE SANTO ANTONIO HOSPITAL OF TENENTE N. Fernandes Loureiro / Lorena L. M. N. Fernandes PORTELA-RS Loureiro / Hospital Ophir Loyola; Rodrigo Custódio R. Aguiar / Rodrigo Custódio R. Aguiar / Hospital Ophir Autores: Ivan Tadeu de Mendonça Junior / MENDONÇA Loyola; Victor F. Ferreira / Victor F. Ferreira / Hospital JR,IT / HOSPITAL SANTO ANTONIO; Daniel Neves Queiroz Ophir Loyola; Fabio A. Morikawa Caldeira / Fabio A. / NEVES,DQ / HOSPITAL SANTO ANTONIO; Luana Dib de Morikawa Caldeira / Hospital Ophir Loyola; Alcyr Araujo Mendonça / MENDONÇA,LD / UNICID. / Alcyr Araujo / Hospital Ophir Loyola; José Gabriel M. da Paixão / José Gabriel M. da Paixão / Hospital Ophir Objective: To report the case of treatment of sub- Loyola; Deise Nunes / Deise Nunes / Hospital Ophir mandibular gland tumor. Method: Patient v.M.R, 72 Loyola; Rafael R. Do Espírito Santo / Rafael R. do Espírito years, brought to the special ambulatory of santo Santo / Universidade Federal do Pará. antonio hospital reporting having right cervical pasta with increasing size for eight years and who feels in Apresentação do caso: D.S.S, 43 anos, sexo masculino, within mouth. Seeked several times specialized service, natural de Belém Pará. Queixa aumento de volume but due to age was not advised to remove injury. The cervical a partir de 2015, ao exame físico em 2017 foi examination had hardened injury, submandibular, and possível observar e palpar massa cervical em topografia without signals of oral cavity. Indirect laryngoscopy de lobo direito de tireóide, de consistência fibroelástica therefore was not demonstrated methods visible e sem outras alterações anatômicas ou queixas clínicas, language and requested face and neck tomography with sendo então solicitada punção aspirativa por agulha venous contrast. The neck tomography shown injury fina (PAAF), obtendo resultado classe III de Bethesda, e
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ultrassonografia de tireóide classificando o nódulo como Santos; Herbert Ives Barretto Almeida / Almeida, H. I. B. Chammas IV, após, foi encaminhado à tireoidectomia / Complexo Universitário Professor Edgard Santos. parcial direita em Março/2018. A peça cirúrgica apresentou nódulo pardo-claro não encapsulado de Apresentação do caso: Paciente de 58 anos do sexo 6cm de diâmetro, e micropatologia demonstrando masculino infectado pelo HCV e diagnosticado em 2012, diagnóstico de tumor trabecular hialinizante em já em vigência de doença crônica parenquimatosa do bócio nodular colóide. Após o recebimento do fígado (CHILD A) e com tumor em segmento III hepático anatomopatológico optou-se pela totalização da de aproximadamente 5,0 cm através de TC de abdome tireoidectomia, realizada em Março/2019, com o novo trifásica. Paciente foi submetido à uma nodulectomia anatomopatológico evidenciando bócio adenomatoso. hepática videolaparoscópica com margens livres Atualmente o paciente mantem seguimento clínico- no final do mesmo ano. Desde então manteve ambulatorial multidisciplinar, em uso de Puran T4® acompanhamento com equipe de gastroenterologia 100mcg 1 vez ao dia, sem queixas. Discussão: O realizando exames de imagem semestrais, através de câncer de tireóide é uma das neoplasias mais comuns USG, TC e RNM de abdome. Em 2016 fez uso de Interferon na região da cabeça e pescoço. Representa 1% dos para tratamento do HCV evoluindo com carga viral tumores malignos na faixa etária dos 30 aos 74 anos, indetectável sustentada. Em março de 2019 realizou TC possui prevalência três vezes maior no gênero feminino, de abdome que evidenciou tumoração em topografia embora esta diferença decline após os 48 anos. O adjacente à hilo esplênico com planos de clivagem, tumor trabecular hialinizante (TTH) é uma neoplasia de aproximadamente 6cm, hipervascularizada. rara derivada de células foliculares da glândula tireóide Paciente encaminhado para abordagem cirúrgica descrita por Carney et al., em 1987, atualmente com sendo identificado, no intra-operatório, tumoração algo em torno de 119 casos relatados. Essa patologia compatível com exame de imagem e procedida a acomete, principalmente, indivíduos que estejam entre ressecção da mesma. Encaminhado o produto para a quarta e sétima década de vida, tendo predileção pelo exame anatomopatológico que revelou histologia de sexo feminino. O TTH é caracterizado por apresentar CHC metastático implantado em omento. Discussão: lesão encapsulada que possui forma homogênea e O Carcinoma hepatocelular é uma neoplasia primaria diâmetro menor ou igual a 2,5cm, geralmente. Alguns do fígado que usualmente se desenvolve em pacientes autores apoiam que se trate de uma variante do que apresentam doenças crônicas do fígado à exemplo carcinoma papilar, outros sugerem que se trate de da cirrose hepática e infecção pelos vírus B e C. Neste um tumor benigno devido ao comportamento não cenário pacientes com doença hepática crônica e, invasivo que apresenta na maioria dos casos. Devido principalmente os que possuem histórico de tumor ao potencial maligno incerto deste tumor, o termo hepatocelular, devem ser rastreados com exames tumor trabecular hialinizante foi adotado pela maioria de imagem rotineiramente para investigação do dos patologistas e pela Organização Mundial de Saúde, surgimento de processos neoplásicos. Metástases refletindo a controvérsia do assunto. Comentários extra-hepáticas ocorrem em aproximadamente entre finais: O TTH de tireóide é evento pouco frequente 5-25% dos pacientes acometidos pelo tumor primário e constitui importante diagnóstico oncológico, ainda do fígado e tem como principais sítios pulmões, necessitando de estudos multicêntricos para sua linfonodos abdominais, ossos e adrenais. O caso em adequada caracterização epidemiológica, assim como questão apresentou evolução atípica, tendo em vista definição de seu perfil biológico para correto manejo o surgimento de lesão metastática em omento, sítio clínico-cirúrgico. incomum, sem a vigência de CHC intra-hepático evidente em tomografia, 6 anos após a ressecção do tumor Contato: Rodrigo Luiz Ferreira Santos primário. Comentários finais: Tendo em vista a alta [email protected] chance de recorrência do carcinoma hepatocelular nos grupos de risco, este trabalho ilustra um caso incomum de implantação pelo CHC em omento, ratificando a TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS importância do acompanhamento radiológico assíduo e CÓDIGO: 87701 de longo prazo neste grupo de pacientes que apresenta doença crônica do fígado. CARCINOMA HEPATOCELULAR: RECIDIVA METACRÔNICA EM OMENTO 6 ANOS APÓS Contato: Victor Hugo Bomfim de Castro RESSECÇÃO DE LESÃO PRIMÁRIA [email protected] Autores: Victor Hugo Bomfim de Castro / Castro, V. H. B. / Complexo Universitário Professor Edgard TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS Santos; Lorenna Lim Santos Andrade / Andrade, L. L. CÓDIGO: 87116 S. / Complexo Universitário Professor Edgard Santos; Bianca da Silva Vinagre Nascimento / Nascimento, B. S. CASE REPORT: PANCREATIC DUCTAL V. / Complexo Universitário Professor Edgard Santos; ADENOCARCINOMA IN A 19-YEAR-OLD Pablo Tarceu Nunes de Melo / Melo, P. T. N. / Complexo Universitário Professor Edgard Santos; Luiz Sérgio PATIENT Do Amaral Júnior / Amaral Júnior, L. S. / Complexo Autores: Gustavo Antônio de Paula Prado / Prado, G.A.P. Universitário Professor Edgard Santos; Heitor Carvalho / HUB-UnB; André Luís Conde Watanabe / Watanabe, Guimarães / Guimarães, H. C. / Complexo Universitário A.L.C. / UnB-HUB; Henrique Barbosa de Abreu / Abreu Professor Edgard Santos; Jorge Luiz Andrade Bastos / H. B. / UnB-HUB; Bruno Gustavo dos Santos / Santos. B. Bastos, J. L. A. / Complexo Universitário Professor Edgard S / UnB-HUB; Henrique Serra de Mello Martins / Martins,
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H. S. M / UnB-HUB; Bruno Rosa de Souza / Souza. B. R. / Hospital Israelita Albert Einstein; Tiago Costa Pádua UnB-HUB; Ana Virginia Ferreira Figueira / Figueira, A.V.F / Padua, T. C / Escola Paulista de Medicina - UNIFESP; / UnB-HUB; Marcela Louise Gomes Rivas / Rivas, M.L.G. Luciana Cristina Silva / Silva, L.C. / Escola Paulista de / Unb-Hub. Medicina - UNIFESP; Carlos Toshinori Maeda / Maeda, C.T. / Escola Paulista de Medicina - UNIFESP; Marcelo Case Report: A 19-year-old female patient came to the Moura Linhares / Linhares, M.M. / Escola Paulista de emergency room complaining of right hypochondrium Medicina - UNIFESP; Gaspar de Jesus Lopes Filho / pain after meals, jaundice, choluria, acholia, and Lopes-Filho, G.J. / Escola Paulista de Medicina - UNIFESP; generalized pruritus for 2 weeks. Physical and laboratory Raphael Leonardo Cunha de Araújo / Araujo, R. L / tests compatible with cholestatic syndrome. US: intra Escola Paulista de Medicina - UNIFESP. and extrahepatic bile duct dilation, with interruption in the periampular region. The patient was admitted Introduction: The treatment of colorectal liver metastases to the General Surgery ward, where she underwent (CRLM) had surgery as the main curative strategy. cholangiography, which confirmed bile duct dilation and However, chemotherapy (QT) has helped to improve showed a distal choledochal filling failure measuring survival and surgical treatment conditions. Patients with 2.3 x 1.2 cm. Abdominal MRI showed a small 1.5 cm good QT response has more chance to resection and nodular aspect area located on the head of the pancreas, those with disease progression (DP) during preoperative compressing the distal choledoccus and protruding over treatment may have surgery contraindicated. The aim its lumen. During hospitalization, the patient evolved of this study is to review the literature to assess whether with worsening of cholestatic symptoms and episodes of there is a role for surgery in the treatment of patients with pain in the right hypochondrium after meals. About 30 disease progression during QT. Methods: The research days after hospitalization and given the complexity of the was performed in 3 databases (MEDLINE, SCOPUS, Web case, she was transferred to a reference hospital, where of Science) until July 10, 2019, following the Preferred she underwent ERCP for biliary drainage and a new Reporting Items for Systematic Reviews and Meta-Analyzes upper abdominal MRI, and the hypothesis of pancreatic (PRISMA). One thousand and thirty-one studies were found tumor was elicited. Indicated duodenopancreatectomy, using the search: (Progression OR “Disease Progression”) performed 90 days after the initial care. During surgery, AND (Surgery OR hepatectomy OR “liver resection”) a tumor was found in the head of the pancreas, AND (“Colorectal Liver Metastases” OR “Colorectal Liver measuring approximately 3 x 3 cm, without vascular Metastasis”). No filters applied. Results: One thousand invasion, as well as perihilar and peripancreatic lymph and thirty-one studies were found and after excluding node enlargement. Histopathological examination of the duplicates and irrelevant articles for this work, 15 were specimen revealed pancreatic ductal adenocarcinoma, selected. Of these 15, 10 indicate DP during or after QT as measuring 1.7 cm, grade 2, affecting the duodenal a negative prognostic factor on survival of patients with wall, duodenal papilla and choledoccus, associated liver metastases of CRLM. The overall survival of patients with adjacent grade 1 and 2 pancreatic intraepithelial undergoing liver resection after DP during QT ranged from neoplasia; neoplasia-free margins; 01/25 affected 8 to 40.1% at 5 years. This review also shows as negative lymph nodes. On immunohistochemistry, CK 7 (+), CEA prognostic factors, those patients with high tumor markers (+), CA 19.9 (+). Staging: pT1 pN1 M0. Patient evolved (CEA, CA 19-9), higher number of secondary lesions, larger uneventfully postoperatively and was referred to the size of metastases, high tumor grade, mutated RAS and Oncology service for follow-up and assessment of shorter disease-free interval. Some authors show no adjuvance possibility. Discussion: In Brazil, pancreatic difference in overall survival between patients undergoing adenocarcinoma accounts for about 2% of all cancers, hepatectomy who did or did not respond to preoperative whose average age of diagnosis is 72 years. Although QT. Others author have shown benefit when operating DP the case described presents a typical clinical picture of patients with lesions up to 5 cm, up to 3 lesions and CEA the disease and an adequate investigation, it proved to up to 200 ng / dL. Conclusion: Although DP during QT is be a diagnostic challenge due to the rarity of this tumor an independent negative prognostic factor, some patients in young individuals. Conclusion: This case is relevant may benefit with surgery based on the role of this modality because it highlights the importance of having pancreatic as the main treatment with curative intent for patients with adenocarcinoma as a differential diagnosis of cholestatic CRLM. In selected cases, based on size, number of lesions syndrome, even in young patients. and tumor markers, surgery may be offered despite the less favorable prognosis and as an option for non-QT Contato: Gustavo Antônio de Paula Prado responders. [email protected] Contato: Jean Michel Milani [email protected] TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS CÓDIGO: 88152 TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS COLORECTAL LIVER METASTASES CÓDIGO: 88100 PROGRESSING DURING CHEMOTHERAPY IS THERE A ROLE FOR RESECTION? SYSTEMATIC EXTENDED MULTI-ORGAN SURGERY FOR REVIEW THE TREATMENT OF GALLBLADDER CANCER: CASE REPORT AND LITERATURE REVIEW Autores: Jean Michel Milani / Milani, J.M. / Escola Paulista de Medicina - UNIFESP / EPM; Bárbara Calixto Autores: Milhem Jameledien Morais Kansaon / Gonçalves Mafra / Mafra, B. C. G / Escola Paulista de Kansaon, M.J.M. / Hospital Alberto Cavalcanti, FHEMIG; Medicina - UNIFESP; Diogo Bugano / Bugano, D. / Matheus de Castro Carvalho / Carvalho, M.C. / Hospital
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Alberto Cavalcanti, FHEMIG; Guilherme Souza / Souza, Lira / Lira, G. A. / Liga Norte Riograndense Contra o G. / Hospital Alberto Cavalcanti, FHEMIG; Ana Paula Câncer; Francimar Kétsia Serra de Araújo / Araújo, Drummond-lage / Drummond-Lage, A.P. / Faculdade F. K. S. / Liga Norte Riograndense Contra o Câncer; Ciências Médicas de Minas Gerais; Alberto Julius André Luiz Costa e Silva / Silva, A. L. C. / Universidade Alves Wainstein / Wainstein, A.J.A. / Hospital Alberto Federal do Rio Grande do Norte; Barbara Paulo Cavalcanti, FHEMIG. Cavalcante / Cavalcante, B. P. / Universidade Potiguar; Marina Fernandes / Fernandes, M. / Case Report: Female, 44 years old, abdominal pain, Universidade Potiguar; Renata Beatriz Bessa choluria and fecal padding, loss of 7kg in the last 30 Teixeira / Teixeira, R. B. B. / Universidade Potiguar; days. She reported previous pancreatitis 15 days Juliana Maria Caetano Nogueira / Nogueira, J. M. C. before, being submitted to endoscopic retrograde / Universidade Potiguar; Víctor José Negreiros de Sá cholangiopancreatography and stent placement. On Rosado / Rosado. V. J. N. S. / Universidade Potiguar; clinical examination, the patient presented icteric, afebrile, Pedro de Albuquerque Mafaldo / Mafaldo, P. A. / eutrophic, with abdomen without signs of peritoneal Universidade Potiguar. irritation or masses. Total abdominal ultrasonography identified gallbladder with multiple calculous formations Case Presentation: M.C.S., 11-year-old, female, and bile duct dilatation. Total bilirubin of 18 (direct 14.4) was referred to an oncology surgery service and increased canalicular enzymes; Ca 19-9 153, CEA 1. after total abdominal computerized tomography In the cholangioresonance observed bile duct dilatation, (CT) scan showed incidentally mass lesion in the the abrupt reduction in the junction of the hepatic ducts pancreas. Magnetic resonance imaging revealed an and hepatocolledoco; the presence of images suggestive expansive, heterogeneous, retroperitoneal lesion, of gallstones in hepatocolledoco and bile duct, pancreas centered in the pancreas, with low signal internal with increased heterogenicity in the cephalic area. septations, areas of cystic appearance and hematic During the procedure: gallbladder lesion with hepatic material inside, showing peripheral and some septa invasion in segment IV and proximal colledochus, without enhancement, measuring 6.0 x 5.8 x 4.9 cm, with vascular involvement. A proximal pancreatectomy was imaging features suggesting pseudopapillary solid performed, with duodenal resection, cholecystectomy, cystic neoplasia (Frantzs tumor). For staging, CT segment IV and V hepatectomy, biliary tract hepatectomy, angiography showed regional venous compression and lymphadenectomy. Resection in monoblock, with without signs of thrombosis or invasion of the superior anastomosis in a single loop. Pathological anatomy: mesenteric vein, splenomesenteric junction, and adenocarcinoma, infiltrating hepatic parenchyma, splenic vein, in addition to arterial contact, without gallbladder wall, choledochus, and duodenal papilla. invasion of celiac trunk bifurcation, common hepatic No neoplasia in the pancreatic and biliary margins artery, and superior mesenteric artery. Then, it was and presence of metastasis in 2/7 lymph nodes of the performed the distal pancreatectomy with partial hepatic hilum. Discussion: Gallbladder cancer (GBC) retroperitoneal lymphadenectomy, preserving the has a low incidence and high mortality. Most patients head of the pancreas and spleen. Currently, awaiting are diagnosed incidentally. The risk of gallbladder results of the histopathological. Discussion: The cancer is usually related to chronic cholecystitis. The solid pseudopapillary pancreatic tumor or Frantzs symptoms are nonspecific, biliary colic-like. Staging is tumor is rare, of unknown etiology, which usually preferably done with cholangioresonance and histology affects young patients, female, involving most often predominates adenocarcinomas. Irresectability criteria the tail of the pancreas. It is a low-grade malignant are distance metastasis, affected lymph nodes, and neoplasm that behaves as benign because it is invasion of large vessels. There is no consensus on unlikely to have an invasion of adjacent structures, adjuvant therapy, performed with chemoradiotherapy. metastases or recurrences. The diagnosis is usually Conclusion: Surgery is the only cure option for GBC. made incidentally due to nonspecific symptoms The case described shows an atypical initial presentation by compression of adjacent organs. Distal surgical of abrupt evolution. It should be noted that cholestatic resection in cases of body or tail injury is the treatment icterus may be an initial manifestation of this suspected of choice because it has a high resectability rate as neoplasm with progression in malaise and weight loss. the tumor displaces adjacent structures rather than The medical decision should address the surgeon‘s invade them. In this case, it was decided to preserve experience, as well as the possibility of resectability the spleen, despite the proximity of the tumor to without increased mortality for the patient. the vessels, because it is an organ of immunological and hematological importance and its removal Contato: Milhem Jameledien Morais Kansaon may result in a higher predisposition to the so- [email protected] called fulminant infection after splenectomy. Final considerations:The pseudopapillary solid pancreatic tumor is rare cancer, low-grade malignancy, with TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS non-specific symptoms. Recurrences may occur and CÓDIGO: 87987 prolonged patient follow-up is required. The etiology remains undetermined, remaining, Frantz‘s tumor, FRANTZ TUMOR RESECTION IN CHILDHOOD an enigmatic tumor needing further clarification. WITH SPLENIC PRESERVATION: A CASE Contato: Amanda Barbetto Medeiros Torres REPORT [email protected] Autores: Amanda Barbetto Medeiros Torres / Torres, A. B. M. / Universidade Potiguar; George Alexandre
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TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS parenchyma and other adjacent structures may benefit CÓDIGO: 88133 those who are sick with long-term morbidity deduction.
FRANTZ TUMOR- THE EXPERIENCE OF THE Contato: Rafael Sousa Santos ONCOLOGICAL SURGERY SERVICE OF THE [email protected] FEDERAL UNIVERSITY OF UBERL NDIA Autores: Marcela Mendonça / Mendonca, M. A. / TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS Universidade Federal de Uberlandia; Paulo Henrique CÓDIGO: 87122 de Sousa Fernandes / Fernandes, P. H. S. / Universidade Federal de Uberlandia; Michel Jamil Chebel / Chebel, M. J. GALLBLADDER SMALL CELLS NEUROEN- / Universidade Federal de Uberlandia; Marcelo Augusto DOCRINE CARCINOMA AND HODGKIN Faria de Freitas / Freitas, M. A. F. / Universidade Federal LYMPHOMA IN A HIV-PATIENT: CASE REPORT de Uberlandia; Yzabella Gomes Fernandes Santana / Santana, Y. G. F. / Universidade Federal de Uberlandia; Autores: Carolina Matté Dagostini / Dagostini, C. M. Rafael Sousa Santos / Santos, R. S. / Universidade / Universidade de Caxias do Sul (UCS); Murillo Cesar Federal de Uberlandia; Camila Leles Nascimento / Gionedis / Gionedis, M. C. / Universidade de Caxias Nascimento, C. L. / Universidade Federal de Uberlandia; do Sul (UCS); Giovani Schulte Farina / Farina, G. S. / Luana Renata Viegas Jorge / Jorge, L. R. V. / Universidade Universidade de Caxias do Sul (UCS); Mariana Gabriela Federal de Uberlandia; Margarida Cândido Guimarães Mandelli / Mandelli, M. G. / Hospital Geral de Caxias do Freire / Freire, M. C. G. / Universidade Federal de Sul (HGCS); Rafael Fontana / Fontana, R. / Universidade Uberlandia; Priscilla Tomi Morikoshi Hirano / Hirano, P. de Caxias do Sul (UCS). T. M. / Universidade Federal de Uberlandia. Case Presentation: Female patient, 55 years old, former The solid pseudo papillary tumor of the pancreas, also alcoholic, former smoker, obese, diagnosed with HIV for known as Frantz tumor is a rare malignant neoplasm 4 years and using antiretroviral therapy. In 2015 she was that accounts for less than 1% of malignant pancreatic diagnosed with Hodgkin‘s Lymphoma. One year after tumors. It usually affects young women, with an average the completion of chemotherapy, systemic revaluation age of 20 years. The clinical presentation may be with total abdominal tomography showed cholelithiasis. asymptomatic, but may be present with abdominal pain Cholecystectomy performed. Anatomopathological or symptoms of compression of adjacent organs. The examination showed undifferentiated malignant indicated treatment is a complete surgical resection, neoplasia affecting the entire wall thickness, with presence which generally has good results, with a low recurrence of perineural infiltration. Radial, proximal and cystic duct rate or distant metastases. We report the experience of surgical limits compromised. Immunohistochemistry has the Oncology Surgery service of the Federal University been shown to be a gallbladder small cells neuroendocrine of Uberlândia in the surgical treatment of Frantz carcinoma. Staging evaluation of T3N0M0. Liver Tumor. Three cases were followed during the period segmentectomy, extrahepatic bile duct resection and of 2009 to 2019, all female patients, aged 28 to 48 hepatic hilum lymphadenectomy were performed. years who presented tumors located in the uncinate Surgical limits and lymph nodes free. Patient evolved well process and in the head of the pancreas. Two patients postoperatively, and maintains regular outpatient follow- underwent a gastro duodenum pancreatectomy (in up, with no evidence of local recurrence or metastasis. the form of Whipple) and the third underwent limited Discussion: Gallbladder cancer is an uncommon but high resection of the neoplasia, preserving pancreatic mortality pathology. The most common histological type is parenchyma and also the duodenum and the bile adenocarcinoma. In the reported case, the patient, on the duct. None of the patients had complications in the other hand, had one of the rarest histological types, the immediate postoperative period. Comparing the small cell neuroendocrine tumor, which is characterized long-term results, both patients who underwent by very aggressive progress. It is more common to be Whipple evolved with exocrine pancreatic insufficiency diagnosed in women from the sixth decade of life and requiring pancreatic enzyme supplementation to often accompanying cholelithiasis. At diagnosis, the tumor maintain nutritional intake, one of which presented is usually at a more advanced stage. Due to the scarce delayed gastric emptying. The patient who underwent literature, there is no consensus on the treatment of this limited resection of the neoplasia evolved with better type of tumor. For localized tumors, cholecystectomy nutritional status, without the need for enzymatic and sometimes hepatic segmentectomy are usually supplementation or other nutrients, but presented performed. Final comments: Our case demonstrates with pancreatitis in the eighteenth postoperative period the importance of cancer screening in patients with with good response to the clinical treatment. Surgery important antecedents. The HIV-infected and obese is the only effective therapy for this type of disease patient developed Hodgkin‘s lymphoma and gallbladder and Whipple mode surgery is widely performed for the neuroendocrine tumor. Despite important comorbidities treatment of neoplasia of the head of the pancreas; and the presence of an aggressive tumor, the case patient however, it is considered a highly complex operation presented an uncomplicated postoperative course. This with prolonged surgical time and may be associated case generates a reflection about the approach of tumors with important morbidity and mortality. The present in patients with antecedents, which may have favorable study demonstrates excellent survival rates associated outcomes. with operative treatment and that, when possible, in selected cases, the option for a more conservative Contato: Giovani Schulte Farina surgical technique with preservation of pancreatic [email protected]
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TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS CÓDIGO: 87513 CÓDIGO: 88298
GASTRODUODENOPANCREATECTOMY: HEMANGIOPERICYTOMA OF LIVER, A RARE CASUISTIC EVALUATION OF A CANCER CASE OF VASCULAR TUMOR SURGERY SERVICE OF MACEIÓ IN 5 YEARS Autores: Janaina Gatto / Gatto, J. / FAG; Ana Clara Autores: Amanda Lira dos Santos Leite / Leite, A. L. Vieira Alexandre / ALEXANDRE, ACV / FAG; Julio Cesar S. / Santa Casa de Misericórdia de Maceió; Aldo Vieira Zanini / ZANINI, JC / Uopeccan; Gabriel Brisot / BRITOR, Barros / Barros, A. V. / Santa Casa de Misericórdia de G / Uopeccan; Mariah Steinbach / STEINBACH, M / Maceió; Filipe Augusto Porto Farias de Oliveira / Oliveira, Uopeccan; Diego Aparecido Gaspar / GASPAR, DA / F. A. P. F. / Santa Casa de Misericórdia de Maceió; Oscar FAG; Marilise Anne Zat / ZAT, MA / FAG; Eduardo Milano Cavalcante Ferro Neto / Neto, O. C. F. / Santa Casa de / MILANO, E / FAG; Fernanda Kreve / KREVE, F / FAG; Misericórdia de Maceió; Claudemiro de Castro Meira Francisco Loss / LOSS, FS / FAG. Neto / Neto, C. C. M. / Santa Casa de Misericórdia de Maceió; Diego Windson de Araújo Silvestre / Silvestre, Case Presentation: A 40-year-old female patient with D. W. A. / Santa Casa de Misericórdia de Maceió; large hepatic adenomatosis and recent bleeding in Tainá Santos Bezerra / Bezerra, T. S. / Santa Casa de hepatic lobe D, segment IV. Enlarged right hepatectomy Misericórdia de Maceió; Thiago Yamamoto Amaral / was performed preserving segments I, II and III. Amaral, T. Y. / Santa Casa de Misericórdia de Maceió; Anatomopathological and immunohistochemical: Alberson Maylson Ramos da Silva / Silva, A. M. R. / antibodies reagent S-100, CD34, FLI-1, MIB-1 (Ki Santa Casa de Misericórdia de Maceió; Elson Alexandro 67 positive by 20%). Immunohistochemical profile Cordeiro Folha Filho / Filho, E. A. C. F. / Santa Casa de consistent with hemangiopericytomahepatico. Misericórdia de Maceió. It required biliodigestive shunt two days after resection because it was not possible to preserve Introduction: Gastroduodenopancreatectomy, a biliary bifurcation due to segment IVb involvement. technique initially described by Kausch and perfected Returns in two months with jaundice, observed bilio- and disseminated by Whipple, is a complex procedure digestive anastomosis stenosis and expansive lesion that allows the cure of selected patients with in the left lung hilar region on CT scans. Exploratory periampular tumors. The procedure requires a high thoracoscopy was requested followed by pulmonary level of experience and standardization regarding the nodule segmentectomy. Kept under chemotherapy technical aspects and perioperative care, due to the treatment. Four months after surgery, subcutaneous high risk of complications, the most common being nodules and hypoattenuating solid nodule in the gastroparesis, pancreatic fistula, bleeding and infectious hepatic segment II of 15x 14mm appear. Seven complications. With advances in technique and increased months later, he started with severe bone pain and surgeon experience, improved anesthetic care and CT with lytic lesions in the axial and appendicular intensive postoperative care, morbidity and mortality skeleton. Second line of chemotherapy started. After rates are decreasing nowadays. Objective: To discuss two months PET-sc showing local recurrence in left the experience of gastroduodenopancreatectomy hepatic lobe and distant metastasis: Two areas in surgeries performed in a cancer surgery service in left hepatic lobe being larger than 11mm and SUV of Maceió. Method: Retrospective study with analysis 2.8 (before 14mm and SUV of 5.5). 25 x 63mm SUV of the service database, tracing the profile of patients 3.9 hypermetabolic area in the left hepatic capsule. operated on from 2014 to 2019, evaluating clinical Third line of chemotherapy started. Death one year and surgical characteristics. Results: Over 5 years, 43 and seven months after diagnosis.Discussion: patients underwent gastroduodenopancreatectoma, Hemangiopericytoma is a vascular tumor that arises with a median age of 60 years, 22 (51%) female and from the Zimmermann pericyte. It may arise in 21 (49%) male. The most common symptoms were several locations, but is most commonly reported jaundice (62% of cases), weight loss (16%) and pain (6%). in extremities and retroperitoneum. However, intra- The most common surgical indication was duodenal abdominal hemangiopericytoma is very rare and is papilla adenocarcinoma, followed by pancreatic head reported in the liver in <1% of cases. It commonly adenocarcinoma and other less common tumors, for affects adults at the age of the fifth or sixth decade malignant and / or benign lesions. Pancreatic-jejunal and may be associated with prolonged steroid anastomosis was performed by ductus-mucosa suture ingestion, trauma or hypertension. The lesion may in 100% of the patients. Operative complications be malignant, but the malignant potential is high. occurred in 34.8% of the cases, mostly due to pancreatic The most common sites of hemanciopericytoma fistula, classified as grade A and B. No patient had grade metastasis are lung, liver and bone. Treatment C fistula. Surgical mortality was 9.3%, mainly due to consists of liver resection with chemotherapy and its hemorrhagic and septic complications. Conclusion: recurrence rate is very high in hemangiopericytoma. Gastroduodenopancreatectomy is a complex surgical Final considerations:Hemangiopericytoma is a rare procedure with non-negligible morbidity and mortality. vascular tumor, which is the least documented in the The data from this research point to the importance of liver. It should be considered one of the differential the experience of a specialized service in highly complex diagnoses of liver mass injury, which increases with surgeries for the better management of these patients. contrast administration.
Contato: Amanda Lira dos Santos Leite Contato: Janaina Gatto [email protected] [email protected]
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TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS a conduta de escolha, também devido ao crescimento CÓDIGO: 87911 acelerado em seis anos da massa hepática benigna e a localização peri-biliar, já com leve compressão das vias HEPATECTOMIA CENTRAL POR VIDEOLAPA- biliares adjacentes. ROSCOPIA EM HAMARTOMA HEPÁTICO Contato: Matheus Pingerno dos Santos Autores: Ariane Elias Antunes / ANTUNES, A. E / [email protected] Universidade do Sul de Santa Catarina - UNISUL; Matheus Pingerno dos Santos / SANTOS, M. P. / Universidade do Sul de Santa Catarina - UNISUL; Italo Mattos Rinaldi / TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS RINALDI, I. M. / Universidade do Sul de Santa Catarina CÓDIGO: 87459 - UNISUL; Murilo Jebai Monteiro / MONTEIRO, M. J. / Universidade do Sul de Santa Catarina - UNISUL; Lucas HEPATIC EMBRYO SARCOMA: CASE REPORT Camargo Gamba Martins Do Amaral / AMARAL, L. C. G. M. / Universidade do Sul de Santa Catarina - UNISUL; Autores: Louise Dèsirèe Sevalho Neves / Neves, Laylla Hanna Rocha Torres de Oliveira / OLIVEIRA, L. H. L.D.S / UEA; Renata Maravieski Pareja / Pareja, R.M / R. T. / Universidade do Sul de Santa Catarina - UNISUL; UEA; Lailson Melgueira Navarro / Navarro, L.M / UEA; Thamy dos Santos / SANTOS, T. / Hospital Nossa Larissa Pessoa de Oliveira / Oliveira, L.P / UFAM; Sidney Senhora da Conceição; Rayssa Pra Buss / BUSS, R. P. / Raimundo da Silva Chalub / Chalub, S.R.S / FCECON. Hospital Nossa Senhora da Conceição; Cassiano Coral Accordi / ACCORDI, C. C. / Hospital Nossa Senhora da Case Presentation: V.G.O, 8 years old, female, brown, Conceição; Luiz Henrique Locks Correa / Correa, L. H. L. from Manaus-Am. She sought urgency with diffuse / Hospital Nossa Senhora da Conceição. abdominal pain, colic, intermittent, continuous fever and malaise. She presented pain on palpation of the O hamartoma mesenquimal hepatico (HMH) e uma lesao right hypochondrium and presence of hardened mass cistica benigna e representa 6% dos tumores hepaticos without peritoneal irritation. The first diagnosis was primarios; na maioria dos casos e assintomatico, pyogenic liver abscess. The patient then underwent sendo muitas vezes diagnosticado acidentalmente em laparostomy to drain the lesion and performed exames ultrassonograficos. A ressecção cirúrgica tem a biopsy. The pathology showed mesenchymal sido o tratamento de escolha, sendo a hepatectomia neoplasia related to hemangioendothelioma type II. a retirada de parte do fígado ou da sua totalidade Immunohistochemistry reported high-grade sarcoma para tratar inúmeras patologias. A hepatectomia por with muscle differentiation. Magnetic resonance imaging videolaparoscopia pode ser utilizada, dependendo da found heterogeneous expansive lesion measuring 5.2x localização e tamanho do tumor a ser retirado. Neste 7.0x 5.8cm. She presented alpha-fetoprotein within caso, buscamos relatar um paciente que realizou normal limits. Surgery was performed for tumor hepatectomia central por videolaparoscopia devido a resection, right hepatic trisegmentectomy, selective hamartoma hepático à direita quanto às apresentações vascular exclusion through the approach of the clínicas e o manejo clínico-cirúrgico. Resultados: glissonian pedicle, associated with partial resection of J.C.N., masculino, 50 anos, história de cisto hepático the monobloc anterior abdominal wall (reconstruction diagnosticado em 2012 e descoberta de aumento de of the abdominal wall was performed with a marlex 6 cm, após seis anos, desse cisto com compressão mesh). The biopsy confirmed the diagnosis of da vesícula biliar. Fez biópsia videolaparoscópica da Undifferentiated Hepatic Embryonic Sarcoma. The massa hepática em outubro/2018, cujo resultado do child underwent adjuvant chemotherapy treatment anatomopatológico foi Hamartoma Hepático. Ao exame according to the protocol without distant disease or físico paciente está corado, hidratado, anictérico, local recurrence. Discussion: Undifferentiated hepatic PA 120/80 mmHg, FC 84 bpm, peso 85kg, Ausculta sarcoma or Undifferentiated embryonal sarcoma of the cardíaca e pulmonar sem particularidades, abdome liver (UESL) is a neoplasm of embryonic origin. Primary lobo esquerdo hepático palpável em epigástrio. O liver neoplasms account for about 2% of pediatric solid paciente trouxe exames de imagem de 2012 e 2018, malignant tumors. The UESL represents 9 to 15% of para comparação: US de abdome (Dez 2012): Volumoso liver tumors and affects children aged 5 to 10 years, cisto hepático, junto à vesícula medindo 8,9 x 7,8 cm; more males. Embryonic liver sarcoma has a prognosis US de abdome (30/08/2018): Volumoso cisto hepático of about one year of survival. In the literature it presents à direita, comprimindo levemente a VB 16,5 x 14,3 just over 150 described cases. The clinical presentation cm. Após as condutas pré-operatórias, a cirurgia is very diverse. Fever may accompany, as noted in foi realizada em novembro/2018, o procedimento the patient. UESL is not associated with high levels of de escolha foi uma hepatectomia central por standard alpha-fetoprotein confirmed in the reported videolaparoscopia com boa evolução pós-operatória. O case. Diagnosis is based on age, alpha-fetoprotein levels, anatomopatológico pós-cirúrgico teve como resultado and imaging exams depending on histopathological and litíase intra-hepático com necrose biliar e infiltrado immunohistochemical examination. In this case, they inflamatório crônico abscedido.Conclusão: A utilização were positive confirming the diagnosis of embryonic de hepatectomias segmentares têm se tornado rotina sarcoma. The combination of radical surgery followed nos centos cirúrgicos como forma de tratamento de by chemotherapy has better survival outcomes. Final diversas afecções hepatobiliares, assim como nos casos comments: UESL is a rare entity. Resection is the best de hamartoma hepático. A hepatectomia central é therapeutic option, followed by adjuvant chemotherapy. indicada para ressecção dos segmentos IV, V e VIII, logo se aplica ao caso em questão, pois o paciente apresenta Contato: Louise Dèsirèe Sevalho Neves lesão nos segmentos V e VIII. A hepatectomia central foi [email protected]
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TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS A 63-year-old male patient was admitted to the CÓDIGO: 82499 Emergency Room complaining of pruritus, abdominal pain, jaundice, choluria, fecal hypocholia and weight loss HEPATOCELLULAR CARCINOMA IN PREVIOUS of 12 kg in five months. Physical examination revealed HYD PATIENT - CASE REPORT jaundice, feverlessness, flaccid abdomen and painful palpation in the right hypochondrium and epigastrium. Autores: Jader David Ricco / Ricco, J.D. / Santa Casa de Denies smoking and alcoholism. Laboratory tests Belo Horizonte; Flávio Henrique Faria e Silva / Silva, F. H. showed increased liver and canalicular enzymes, with F. / Santa Casa de Belo Horizonte. obstructive hyperbilirubinemia. Abdominal ultrasound showing left intrahepatic bile duct dilatation. CT and MRI Hepatocellular carcinoma is the most common type of of the abdomen with expansive and infiltrative lesion primary liver cancer. It is a solid lesion strongly related to involving the bile duct, invading the pancreas head. He cirrhosis, especially those associated with hepatitis B and underwent percutaneous bile duct drainage for clinical C infection. It is estimated that only a portion between stabilization with posterior retrograde endoscopic 7 and 12% of HCC cases develop in non-cirrhotic livers. cholangiopancreatography. ERCP revealed segmental The case reported here is a 65-year-old patient with no stenosis of proximal hepatocholococcus, with endoscopic previous comorbidities, with pain in hypochondrium papillotomy and placement of biliary prosthesis. Due to D and an image strongly suggestive of hepatocellular the suspicion of DRIgG4, biliary biopsies were performed carcinoma. The aforementioned patient was treated at by means of echoendoscopy, which showed mixed the authors‘ service with initial right hypochondrium pain. inflammatory lymphoplasmacytic infiltrate, with positive Propaedeutic with signs suggestive of hepatocellular IgG4 in most plasmacytic cells, negative for neoplasia. carcinoma. No comorbidities. Former alcoholic, with The association of imaging findings and histopathology cessation of addiction for 15 years. Former smoker for supports the diagnosis of DRIgG4. After ERCP, the 20 years. Preserved liver function, no history of prior patient presented significant remission of the clinical liver disease. Alphafetoprotein levels within normal and radiological picture, remaining in outpatient follow- range. Serology for negative hepatitis B and C. Magnetic up, with good evolution. IgG4-related diseases (DRIgG4) resonance imaging identified a large segment-centered began to be recognized as a clinicopathological entity neoplastic expansive formation, leading to bulging of the in 2003. They include manifestations in various organs, hepatic contour at the level of the hilum, measuring 8.5 such as major involvement, pancreas and biliary tree. x x7.5 x 8.3 cm. Such lesion presenting predominantly Histopathological features are the basis of the diagnosis. peripheral arterial enhancement, with Wash-out and They are defined as: lymphoplasmocyte infiltrates rich pseudocapsule formation, as well as an entourage in IgG4 positive tissue plasma cells. It presents as extra contour with areas of necrosis / liquefaction. Formation pancreatic manifestations, bile duct thickening, stenosis, exerting a compressive effect on the gallbladder and the irregularity and upstream dilation, as well as renal second duodenal portion, without signs of invasion. Exam alterations. This Clinic resembles Primary Sclerosing report suggesting consider hepatocellular carcinoma Cholangitis (CEP), making it difficult to differentiate as a first hypothesis. Colonoscopy and upper digestive them. However, patients with CEP are less symptomatic endoscopy without neoplastic signs. Given these tests, and their lesions tend to be multifocal, in short intra we decided to perform extended left hepatectomy, or extrahepatic segments. On the other hand, IgG4 performed on 21/11/2017. Non-cirrhotic patients with sclerosing cholangitis typically presents continuous HCC, although far less frequent than cirrhotic patients, lesions with pre-stenotic dilation. have good treatment possibilities and considerable five- year survival rates. Contato: Henrique Acácio Barbosa [email protected] Contato: Jader David Ricco [email protected] TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS CÓDIGO: 87123 TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS CÓDIGO: 87646 IN SITU DUODENAL AND INVASIVE GALLBLADDER ADENOCARCINOMA IN A IGG4-RELATED DISEASE: CASE REPORT NON-CLASSIC FAP PATIENT: CASE REPORT Autores: Raquel de Maria Maués Sacramento / Autores: Renata Rauber Felkl / Felkl, R. R. / Universidade Sacramento, R. M. M. / Hospital Porto Dias; Marcos de de Caxias do Sul (UCS); Carolina Matté Dagostini / Souza Lopes Freire Filho / Freire Filho, M. S. L. / Hospital Dagostini, C. M. / Universidade de Caxias do Sul (UCS); Porto Dias; Patrícia Isabel Bahia Mendes Freire / Freire, Giovani Schulte Farina / Farina, G. S. / Universidade P. I. B. M. / Hospital Porto Dias; Larissa de Albuquerque de Caxias do Sul (UCS); Mariana Gabriela Mandelli / Mota / Mota, L. A. / Hospital Porto Dias; Ana Caroline Mandelli, M. G. / Hospital Geral de Caxias do Sul (HGCS); Sobrinho Dias / Dias, A. C. S. / Hospital Porto Dias; Rafael Fontana / Fontana, R. / Universidade de Caxias Henrique Acácio Barbosa / Barbosa, H. A. / Hospital do Sul (UCS); Fernando de Marco dos Santos / Santos, Porto Dias; Fábio Sales Frota / Frota, F. S. / Hospital F. M. / Hospital Geral de Caxias do Sul (HGCS); Aline Porto Dias; Eduardo Duarte Espíndola / Espíndola, E. Caldart Tregnago / Tregnago, A. C. / CPM Laboratório. D. / Hospital Porto Dias; Lucas Jervan Miranda Meireles / Meireles, L. J. M. / Hospital Porto Dias; Ruan Gabriel Pinho Botelho dos Santos / Santos, R. G. P. B / Hospital Case Presentation: A 77-year-old female patient Porto Dias. underwent total prophylactic colectomy 23 years ago
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for multiple colonic adenomatous polyps. Considering / Liga Acadêmica de Oncologia do Hospital de Base do the patient‘s advanced age at diagnosis, it was Distrito Federal; Mylena Valadares Silva / Silva, M. V. / suggestive that it was about a non-classical form of Liga Acadêmica de Oncologia do Hospital de Base do Familial Adenomatous Polyposis (FAP). Follow-up Distrito Federal; Thaynara de Carvalho Ribeiro / Ribeiro, upper GI endoscopy with biopsy showed multiple T. C. / Liga Acadêmica de Oncologia do Hospital de Base tubulo-villous adenomas with high-grade dysplasia do Distrito Federal; Bruno José de Queiroz Sarmento / in the second duodenal portion and Vater‘s ampoule. Sarmento, B. J. Q. / Unidade de Cirurgia Oncológica do Gastroduodenopancreatectomy and cholecystectomy Instituto Hospital de Base; Rodrigo Nascimento Pinheiro were performed. Anatomopathological examination / Nascimento, R. N. / Unidade de Cirurgia Oncológica do revealed intraepithelial adenocarcinoma associated Instituto Hospital de Base. with extensive marked duodenal mucosa dysplasia, with pancreatic duct involvement. In the gallbladder, Case Presentation: LWA, male, 43 years, pre-diabetes, moderately differentiated adenocarcinoma with overweight, previous smoking, maternal history of biliary invasion of the lamina propria associated with tubular cancer. Presented with asymptomatic cholelithiasis on adenoma with high-grade dysplasia measuring 2.5 cm radiological exams and underwent cholecystectomy. was identified. Surgical limits and lymph nodes were Postoperatory biopsy showed signs of chronic free. The patient has regular outpatient follow-up, cholecystitis, low-grade dysplasia and an free, isolated with no evidence of local recurrence or metastasis. adenocarcinoma fragment, with no involvement of its Discussion: FAP is the most common adenomatous wall. Immunohistochemistry suggested origin on biliary polyposis syndrome, characterized by multiple tract. Dosage of CA 19-9 was 292.4 U/mL. Staging exams colorectal adenomatous polyps. The attenuated form of did not evidentiate metastases and he was reoperated for FAP is characterized by less than 100 colorectal polyps resection of the gallbladder bed margin and hepatic hilum between the ages of 40 and 70, with an estimated lymphadenectomy and cystic duct margin. Pathology 70% risk for colorectal cancer. Patients with FAP have showed surgical specimens and 6 lymph nodes free of a high risk of developing malignancies in the upper residual disease and the patient has been under follow- gastrointestinal tract, the duodenum being the most up, free of disease for 9 months. Discussion: Gallbladder frequent extracolonic topography of polyps (30-70%), (CV) cancer is the most common among biliary tract with a cumulative risk of 3-10% for duodenal cancer. In neoplasms, despite the estimated worldwide incidence of addition, rare reports describe the association of FAP 2/100,000, which is larger on developing countries. It is up with adenomas and gallbladder cancer. Spigelman‘s to 3 times more common in women especially because classification assesses the severity of duodenal of the greater incidence of chronic cholecystitis. Other polyposis, defining five stages according to size, number, risk factors include obesity, hyperglycemia, infections, histology and severity of polyps. The therapeutic inflammatory bowel disease, and primary sclerosing decision for duodenal polyposis is defined according to cholangitis. It was demonstrated 26% of family relationship Spigelman‘s five stages, which estimate the frequency and maternal transmission is preponderant. The anatomy of endoscopy and the need for chemoprevention or of gallbladder, being adjacent to the liver, facilitates hepatic surgery. Final comments: Our case demonstrates the invasion and metastatic progress is mainly responsible importance of screening for extracolonic neoplasms for its poor prognosis. Overall 5-year survival ranges from in patients with FAP and generates a reflection about 5% to 32% and only 10% are diagnosed while restricted the approach of high gastrointestinal polyps, which to the gallbladder. The most prevalent histologic type is have a chance of malignant transformation. The adenocarcinoma, most commonly diagnosed incidentally, best therapeutic strategy for these lesions should be after cholecystectomy for benign disease. Surgical individualized according to the characteristics of the reapproach may be indicated in this situation. Surgery polyps and the patient clinical condition. is the curative treatment, conferring good oncologic results in the early stages and should be associated with Contato: Giovani Schulte Farina adjuvancy in applicable cases. Final comments: Given [email protected] the risk factors presented and family history, differential diagnosis is essential even in the face of the rarity of this cancer. We discuss this unusual clinical manifestation, TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS considering the aggressiveness of the disease and the CÓDIGO: 87734 benefit of follow-up and case management by specialized professionals. INCIDENTAL FINDING OF ADENOCARCINOMA IN A GALLBLADDER LUMEN WITH NO WALL Contato: Renata Pereira Fontoura INVOLVEMENT [email protected] Autores: Renata Pereira Fontoura / Fontoura, R. P. / Liga Acadêmica de Oncologia do Hospital de Base do TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS Distrito Federal; Paulo Henrique Rodrigues Correia CÓDIGO: 87151 / Correia, P. H. R. / Liga Acadêmica de Oncologia do Hospital de Base do Distrito Federal; José Donato de KLATSKIN - CS IVB PERIHILARY Sousa Netto / Netto, J. D. S / Liga Acadêmica de Oncologia CHOLANGIOCARCINOMA IN 26-YEAR do Hospital de Base do Distrito Federal; Kétuny da Silva Oliveira / Oliveira, K. S. / Liga Acadêmica de Oncologia PATIENT: CASE REPORT do Hospital de Base do Distrito Federal; Amarildo Autores: Rafael Fontana / Fontana, R. / Hospital Geral Henrique da Conceição Junior / Conceição Junior, A. H. de Caxias do Sul; Fernando de Marco dos Santos /
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Santos, F.M / Hospital Geral de Caxias do Sul; Fernando EBMSP - LANACC/FMB; Henrique Larocca Peres / Peres, dos Santos Bitencourt / Bitencourt.F.S / Hospital Geral H.L. / EBMSP - LANACC/FMB; José Victor Dias Lavigne / de Caxias do Sul; Mariana Gabriela Mandelli / Mandelli, Lavigne, J.V.D. / EBMSP - LANACC/FMB; Miguel Angelo M.G / Hospital Geral de Caxias do Sul; Bruna Lucchese Mota de Almeida Maia / Maia, M.A.M.A. / EBMSP - Meinerz / Meinerz.B.L / Universidade de Caxias do Sul; LANACC/FMB; Paulo José Lima Cardoso Filho / Cardoso Eduardo Pohlmann Filho / Filho, E.P / Universidade Filho, P.J.L. / EBMSP - LANACC/FMB; Pedro de Brito de Caxias do Sul; Jéssica Salua Pasquetti / Pasqualetti, Oliveira / Oliveira, P.B. / EBMSP - LANACC/FMB; Pedro J.S / Universidade de Caxias do Sul; Camila Barbosa Paulo Santos Areias Vianna / Vianna, P.P.S.A. / EBMSP Saueressig / Saueressig, C.B / Universidade de Caxias do - LANACC/FMB; Ana Celia Diniz Cabral Barbosa Romeo Sul; Marília Caroline Breyer / Breyer, M.C / Universidade / Romeo, A.C.D.C.B. / FMB/UFBA; André Luis Barbosa de Caxias do Sul; Carolina Matté Dagostini / Dagostini, Romeo / Romeo, A.L.B. / EBMSP. C.M / Universidade de Caxias do Sul. Introduction: Malignant pancreatic neoplasia is the Case Presentation: A 26-year-old female patient fourth leading cause of cancer death in the United presented with progressive jaundice. Magnetic resonance States, with 5-year survival limited to approximately 8%. imaging showed enlarged lymph nodes near the hepatic In addition, it usually presents at an advanced stage even hilum; infiltrative aspect hepatic hilum lesion, causing when diagnosed shortly after the onset of symptoms, intrahepatic bile duct obstruction at the confluence of the which are often nonspecific. Objective: To perform a right and left lobe bile ducts and consequent upstream comparative analysis of cases of malignant pancreatic dilatation; and nodular lesions of varying sizes and neoplasia in Brazil considering gender, race and other random distribution throughout the liver parenchyma, variables over a decade, considering that this type of presumably related to secondary implants. Patient tumor is an insidious disease with late symptomatology, referred for exploratory laparotomy. In the intraoperative which delays and makes its diagnosis difficult. Given this, period, multiple liver metastasis and tumors were fatal outcomes are not uncommon, and understanding observed, affecting and amputating the confluence the variables listed in this analysis becomes valuable of the right and left hepatic ducts, associated with because it allows both prevention and more effective purulent content output. Cholecystectomy and internal action against this comorbidity by the health system. transtumoral biliary drainage were performed. Freezing Method: This is an ecological study with a quantitative, examination of liver injury suggested cholangiocarcinoma descriptive and temporal approach. From the Sistema metastasis. Immunohistochemistry through positive Único de Saúde database (DATASUS), hospitalizations markers CK19, CA 19-9, CK7 and CDX2 confirmed the for pancreatic malignant neoplasia in Brazil between diagnosis of cholangiocarcinoma. The radiological and 2008 and 2018 were evaluated. The variables studied surgical evaluation classified the tumor as Bismuth- were: number of hospitalizations, deaths and total value Corlette type II, stage IV with liver metastases. Patient by region, gender and race. Results: During the study had a good postoperative evolution, with improvement period, there were 80,199 hospitalizations for pancreatic of clinical symptoms and jaundice resolution. Referred to cancer in Brazil, with 40,640 corresponding to male clinical oncology for follow-up and palliative chemotherapy patients and 39,559 to female patients. Of all the cases, with FOLFOX due to disease progression. Discussion: 40,184 (50%) hospitalizations corresponded to white Cholangiocarcinoma is a malignant neoplasm that occurs patients, compared to 20,382 (25%) brown patients, and in biliary epithelial cells. About 50% have metastasis at only 3,095 (4%) to black patients, 817 (1%) asians and the time of diagnosis and resectability rates in localized 28 indigenous. Of which 15,693 (20%) patients do not disease range from 10% to 85%. In cases with metastasis declare their race. It was also observed that between or unresectability treatment of jaundice and subsequent 2008 and 2018 there was an increase of approximately chemotherapy represent the best strategy. Percutaneous 194% in the total number of hospitalizations, with the biliary prostheses represent the best option, however, number of male patients increasing by 186% and female, they are not available in all media, especially in the Sistema 203%. Conclusion: The number of hospitalizations did Único de Saúde (SUS). Thus, according to our reality, we not vary widely between genders, however, among the only have the surgical route and we lack specific biliary races, the discrepancies were noteworthy, highlighting prostheses, generating the need to use a multifunction the high rate of hospitalizations among self-reported urethral tube. Final comments: Despite the unfavorable white patients, which may reflect greater access to health metastatic clinical presentation and despite the logistical services of this group. It was also noticed that the number deficiencies, we considered it important and obtained the of hospitalizations had a very significant growth, and it is resolution of jaundice in a young patient with performance up to this analysis on possible causalities associated with status I for subsequent systemic treatment. such event in future studies.
Contato: Fernando dos Santos Bitencourt Contato: Caenna Corrêa e Correia [email protected] [email protected]
TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS CÓDIGO: 87777 CÓDIGO: 88205
MALIGNANT PANCREATIC NEOPLASIA: A NEUROENDOCRINE DIFFUSE PANCREAS COMPARATIVE ANALYSIS OF VARIABLES TUMOR: AN UNUSUAL PRESENTATION Autores: Caenna Corrêa e Correia / Correia, C. C. / FMB/ Autores: Priscila Nunes Silva Morosini / MOROSINI, UFBA - LANACC/FMB; Felipe Pinto Dantas / Dantas, F.P. / P. N. S. / HOSPITAL SÃO VICENTE; Priscila Nunes Silva
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Morosini / MOROSINI, P. N. S. / HOSPITAL SÃO VICENTE; and celiac plexus neurolysis. The microscopic analysis Agata Rothert / ROTHERT, A. / HOSPITAL SÃO VICENTE; of the specimen confirmed pancreatic adenocarcinoma. Mariana de Castro / CASTRO, M. de / HOSPITAL SÃO The treatment of choice was chemotherapy with VICENTE; Nayara Greselle / GRESELLE, N. / HOSPITAL Gemcitabine for 6 months. CT scan and Magnetic SÃO VICENTE; Marcela Santos Cavalcanti / CAVALCANTI, Resonance (MR) after the treatment showed no signs M. S. / NEOPATH; Marciano Anghinoni / ANGHINONI, M. of pancreatic tumor. Follow up with clinical and surgical / HOSPITAL SÃO VICENTE. oncologist for the past 9 years showed no evidence of recurrent disease, no distant metastases and values Presentation: Female, 54 years old, with abdominal of serum tumor markers in normal range. Discussion pain with 2 months of progression, associated with Pancreatic adenocarcinoma is a malignant tumor transitory jaundice and weight loss. Previously she was usually diagnosed in patients over 40 years old, with its cholecystectomized and a recent diabetes diagnosis. peak incidence occuring in the seventh decade of life On physical exam, she was with jaundice and no and incidence roughly equal for the sexes. Pancreatic abdominal mass was present. Laboratory examinations cancer has high morbimortality rate and its 5-year showed elevation of CA 19-9 (66,2) Gama GT (1.520) survival rate is about 8%. The difficulty in early diagnosis alkaline phosphatase (764) and total bilirrubins (2,3). is due to the lack of symptoms in inicial stages. When The MRI of biliary tree demonstrated a mild distension present, symptoms usually are non-specific: abdominal of biliary tract, and the pancreas was entirely enlarged pain, unintended weight loss, nausea and vomiting. and wholly affected by heterogeneous diffuse neoplasic Symptoms vary according to localization and size of lesion. An echoendoscopy showed a infiltrative lesion the tumor. Lesions in the pancreatic head may cause affecting all the pancreas, with a point of choledochal obstruction of the bile duct, leading to jaundice, obstruction. A pancreatic biopsy was proceed, and the choluria, faecal acholia and pruritus. Abdominal and histopathological findings were a well differentiated back pain may be caused by tumoral invasion of the neuroendocrine tumor, envolving all the pancreas. celiac plexus. Final considerations Surgical ressection Toward the global involvement of the pancreas, a total is the only pottentialy curative technique for managing pancreatectomy, splenectomy and lymphadenectomy pancreatic cancer, however, more than 80% of patients was proceed. One lymph node was affected. The present with disease that cannot be cured with surgical Immunohistochemistry revealed a positive pattern ressection, even with multimodal treatment involved. for chromogranin and synaptophysine and a Ki-67 The investigation for tumor recurrence or distant of 4,3%. Discussion: pancreatic neuroendocrine metastases requires imaging exames, further biopsies tumors usually are focal and its treatment is resection: and serum tumor markers. In this case report, the from enucleation to Whipple surgery. Untypically , in patient had a tumor in the pancreatic head of 4,2 x 3,7 this case, a total pancreatectomy was need for a R0 x 3,3cm that was no longer visible in imaging exams ressection. Final comments: the surgical approach after chemotherapy with Gemcitabine. The fragment of pancreatic neuroendocrine tumors is the core of extracted for the biopsy was 1,2 x 0,6 x 0,4cm and it curative treatment in this kind of lesion. Specifically in was reviewed in more than one occasion by different this patient we faced a challenge: the need of a total pathologists, confirming a pancreatic adenocarcinoma pancreatectomy. that showed no sign of recurrence in the past 9 years.
Contato: Ágata Rothert Contato: Guilherme Wiese Roeder [email protected] [email protected]
TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS CÓDIGO: 88327 CÓDIGO: 87262
NINE YEARS FREE OF PANCREATIC PALIATIVE SURGICAL TREATMENT ON ADENOCARCINOMA AFTER CHEMOTHERAPY: PANCREATIC HEAD TUMORS IN A REFERENCE CASE REPORT ONCOLOGICAL HOSPITAL IN PARÁ Autores: Fernando Papp / Papp, F. / Associação Autores: Lorena Luiza Maria Nogueira Fernandes Hospitalar São José; Carina Yumi Takahashi / Loureiro / FERNANDES LOUREIRO, L. L. M. N. / HOSPITAL Takahashi,C.Y. / Associação Hospitalar São José; OPHIR LOYOLA; Rafael Maia de Sousa / SOUSA, R. Guilherme Wiese Roeder / Roeder,G.W. / Associação M. / HOSPITAL OPHIR LOYOLA; Rodrigo L. F. Santos / Hospitalar São José; Sasha Keith Kovaliuk / Kovaliuk,S.K. SANTOS, R. L. F. / HOSPITAL OPHIR LOYOLA; Rodrigo / Associação Hospitalar São José. Custódio R. Aguiar / AGUIAR, R. C. R. / HOSPITAL OPHIR LOYOLA; Fabio A. Morikawa Caldeira / CALDEIRA, F. Case Description A 57-year-old male, former smoker, A. M. / HOSPITAL OPHIR LOYOLA; Victor, F. Ferreira / negative family history for cancer, no previous FERREIRA, V. F / HOSPITAL OPHIR LOYOLA. surgeries. Presented with abdominal pain and jaundice, high levels of bilirrubin (total 7,0mg/dL), CA19-9 of 38U/ Introduction: Pancreatic neoplasms are one of the mL and CEA 0,5ng/mL. The computed tomography most aggressive tumors of the digestive tract and only 15 (CT) showed a lesion in the pancreatic head of 4,2 x to 20% of patients are diagnosed with resective cancer 3,7 x 3,3 cm and dilation of the bile duct. The patient surgery. In this context it is important to place palliative underwent open laparotomy for pancreatic biopsy, surgical treatment as an important therapeutic option. biliodigestive derivation with Roux-en-Y anastomosis Objective: To evaluate the surgical techniques used
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for the palliative treatment of advanced pancreatic as insulinomas and gastrinomas. Non-functioning head tumors in patients at the Ophir Loyola Reference TNE-P are usually detected incidentally in imaging Cancer Hospital in Belém, Brazil. Methods: Descriptive, studies for another reason. In addition to functional observational, cross-sectional, retrospective research. classification, the World Health Organization classifies We included 18 medical records referring to patients them according to aggressiveness: well-differentiated with advanced pancreatic head cancers who underwent are separated into two categories according to the a palliative surgical procedure at Ophir Loyola Hospital proliferation rate: low grade (grade 1) and intermediate from January 1, 2010 to December 31, 2015. The study grade (grade 2); the poorly differentiated are all of high was carried out through a review of Surgical reports, grade (grade 3), presenting highly aggressive behavior analyzing general data such as epidemiology, aspects and clinical manifestation similar to small or large lung related to the tumor, intraoperative finding that cell neuroendocrine carcinomas. Objectives: To report indicated tumor nonresectability and surgical technique the case of a patient with a well-differentiated (grade employed. Data was tabulated using Microsoft Office 1) neuroendocrine pancreatic tumor discovered at Excel 2007 software, for statistical analysis, BioEstat 5.0 random. Methods: Patient A.L.M., female, 73 years old, and for publishing the text of Microsoft Office Word 2007. Caucasian, with a history of hypothyroidism, systemic Results: 166 patients with pancreatic neoplasia were arterial hypertension, dyslipidemia. Computed identified in the study period. Of these, 18 underwent tomography showed a solid nodule measuring 6x4 cm, palliative surgical treatment for advanced pancreatic located near the hepatic hilum, determining inferior cancer. The mean age of the patients was 61 years. The vena cava compression. MRI abdomen with three most affected age group was patients over 60 years old small nodular images, located in segment VII, V and (61.11%), the majority of whom were male (72.22%). The VI, measuring 8umm, 4mm and 5mm. Results: The majority of patients were from cities in the interior of patient underwent laparotomy for retroperitoneal the state of Pará (83.33%). The intraoperative findings tumor resection in oncology + retroperitoneal that determined the criterion of tumor nonresectability lymphadenectomy in oncology + partial hepatectomy in were the invasion of the superior mesenteric vessels oncology. Pathology - pancreas: epithelioid neoplasia, (55.56%) for the artery and 50% for the superior retroperitoneal lymph nodes compromised by neoplasia mesenteric vein, portal vein invasion (38.89%) and 2/11; liver affected by the neoplasm. IHC showed a hepatic metastasis (33, 33%). Three types of bile well-differentiated grade 1 neuroendocrine tumor. diversion were observed: hepaticojejunoanastomosis Conclusion: The surgical approach remains to be the (38.89%), choledochnojejunoanastomosis (55.56%) and therapy of choice for patients with resectable ENT. Due transcystic biliary drainage (5.56%). 83.33% performed to the high cure rates obtained with surgical intervention, diversion of the digestive transit associated with bile insulinomas have resection as the treatment of choice. derivation. Lymph node biopsy was the most commonly For non-functioning tumors, when its size exceeds 2 cm, used complementary measure (27.78%). Conclusion: surgical treatment is recommended, whether or not the It is believed that these findings are relevant and patient has multiple endocrine disease type 1. will contribute to the planning of palliative surgical treatment for the patient with advanced pancreatic Contato: Murilo Jebai Monteiro head neoplasia, with the aim of To provide better [email protected] medical care at this crucial point in the lives of these patients. TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS Contato: Lorena Luiza Maria Nogueira Fernandes Loureiro CÓDIGO: 88111 [email protected] PARENCHYMA-SPARING, LIMITED RESECTION OF PANCREATIC HEAD FOR TREATMENT OF TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS CÓDIGO: 87671 LOW RISK PERIAMPULLARY NEOPLASIA Autores: Marcela Almeida Mendonça / Mendonça, M. A. PANCREATIC NEUROENDOCRINE TUMOR / Universidade Federal de Uberlândia; Paulo Henrique de Sousa Fernandes / Fernandes, P. H. S. / Universidade Autores: Murilo Jebai Monteiro / Monteiro, M.J / Unisul; Federal de Uberlândia; Michel Jamil Chebel / Chebel, Cassiano Coral Accordi / Acordi, C.C / Unisul; Luiz M. J. / Universidade Federal de Uberlândia; Marcelo Henrique Locks Correa / Correa, L.H.L / Unisul; Rayssa Augusto Faria de Freitas / Freitas, M. A. F. / Universidade Pra Buss / Buss, R.P / Unisul; Nicolas Girardi / Girardi, N / Federal de Uberlândia; Rafael Sousa Santos / Santos, R. Unisul; Eduardo Gioppo Calegari / Calegari, E.G / Unisul; S. / Universidade Federal de Uberlândia; Camila Leles Matheus Pingerno dos Santos / Santos, M.P / Unisul; Nascimento / Nascimento, C. L. / Universidade Federal Lucas Camargo Gamba Martins Do Amaral / Amaral, de Uberlândia; Yzabella Gomes Fernandes Santana / L.C.G.M / Unisul; Emanuel Felipe Vieira Luz / Luz, E.F.V / Santana, Y. G. F. / Universidade Federal de Uberlândia; Unisul; Bruna Depieri Michels / M, B.D / Unisul. Luana Renata Viegas Jorge / Jorge, L. R. V. / Universidade Federal de Uberlândia; Margarida Cândido Guimarães Introduction: Pancreatic neuroendocrine tumors Freire / Freire, M. C. G. / Universidade Federal de (TNE-P) represent 10% of all neuroendocrine Uberlândia; Priscilla Tomi Morikoshi Hirano / Hirano, P. neoplasms, they have an incidence of 0.5 cases per T. M. / Universidade Federal de Uberlândia. 100,000 people per year and correspond to about 3% of pancreatic neoplasms. 30% of TNE-P are said to be E. E. S. C., female, 32 years old, submitted to functioning, the most common are insulin or gastrin appendectomy after acute inflammatory abdomen. production. 70% are classified as non-functioning
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In the intraoperative period, a large retroperitoneal Hospitalar São Francisco de Assis; Marcos Ros Zambelli mass was seen, apparently without correlation with de Almeida / Almeida,M.R.Z. / Complexo Hospitalar São the condition. Subsequent investigation performed Francisco de Assis. a magnetic resonance imaging that identified a well- defined heterogeneous mass near aorta and vena cava Paciente D.B.S,34 anos,admitida na instituição em pré- with compression of adjacent structures. Endoscopic operatório de Colecistectomia Videolaparoscópica. ultrasound was performed to confirm the finding of a Paciente com quadros recorrentes de dor abdominal, solid-cystic retroperitoneal lesion. An ultrasound guide maior em epigástrio.Apresentava ainda perda de puncture was performed and the anatomopathological peso,náuseas e vômitos.Em Ultrassonografia (USG) de report revealed a micropapillary lesion suspect of abdome total:vesícula biliar de conteúdo anecóico,com carcinoma. An elective surgical approach was performed, vários cálculos em parede posterior;Colangioressonância: and an oval lesion of approximately 10 cm was found in sem sinal de Coledocolitíase.Em 11/2017, foi submetida the uncinate process of the pancreas, in close contact a Colecistectomia Videolaparoscopica, evoluindo with the duodenum and bile duct. Choledoccus was bem em pós operatório.Frequentemente a paciente observed in anomalous position, whose pathway passed recorria com Pancreatite Aguda;Realizou nova externally to the uncinate process, displaced by the large Colangioressonância em 03/2018:lesão expansiva cística mass, and whose implantation occurred in the posterior em corpo do pâncreas, medindo 6 x 4 cm.Paciente part of the second portion of the duodenum. Opted to iria realizar Colangiopancreatografia retrógrada perform limited resection of the neoplasia (preservative endoscópica (CPRE),mas por falta de material,foi optado of pancreatic parenchyma, duodenum and choledoccus), por realização de USG Endoscópica,feito punção do with excision of the uncinate process and pericoledocian cisto pancreático com achado em material colhido lymph node resection. During the mass removal, negativo para malignidade;Em 05/2018 foi submetida incomplete section of the bile duct occurred, performed a laparotomia exploradora,com achados de volumosa primary fix and Kehr drain positioning. The patient had lesão cística pancreática não aderida a parede posterior a good postoperative evolution and was discharged four do estômago;Realizado Cistoenteroanastomose days later. Returned to the institution on the eighteenth termino lateral em y de roux;Paciente evoluindo postoperative day with abdominal pain, vomiting and bem,porém como não houve melhora do quadro elevation of pancreatic enzymes, was diagnosed with álgico e em exame de TC de abdome de controle pancreatitis, with good response to clinical treatment. foi evidenciado presença de Pseudocisto residual Pathology revealed solid pseudopapillary pancreatic com discreto aumento de pâncreas.Em 07/2018 neoplasia (Frantz‘s tumor) with free surgical margins. foi submetida em segundo tempo a laparotomia Frantz‘s tumor is a rare tumor with low malignancy, exploradora,sendo achados:lesão cística em topografia as long as it can be completely resected. Found in de corpo e cauda de pâncreas.Realizado esplenectomia 90% of cases in young female patients. Despite the e pancreatectomia de corpo e cauda.Enterectomia large local growth, it rarely invades organs or adjacent de alça em y de roux da Cistoenteroanastomose. vascular structures. The clinical presentation is often Em Anatomopatológico:carcinoma pancreático of abdominal pain associated with the tumor, but the indiferenciado com células gigantes tipo osteoclásticas. condition may be asymptomatic. Tumor excision usually Imuno-histoquímica: adenocarcinoma ductal pancreático does not require extensive resections. In this case it de alto grau.Paciente evoluindo bem em pós operatório was possible to remove the tumor with preservation of e recebendo alta hospitalar.Em tempo, a paciente noble structures (duodenum, bile duct and head of the segue realizando acompanhamento ambulatorial com pancreas), despite its large size and location (uncinate oncologia clínica. Discussão: O Pseudocisto Pancreático process). The respective procedure contributed to the é a complicação mais frequente após um surto de reduction of morbidity / mortality frequently associated pancreatite aguda,é definido como uma coleção de with conventional pancreatectomies. suco pancreático encapsulado por uma parede fibrosa não epitelizada.Os pseudocistos da pancreatite aguda Contato: Marcela Almeida Mendonça regridem em 40% dos casos.Os maiores que 5cm de [email protected] diâmetro e que persistem por mais de 6 semanas devem ser considerados para drenagem. Comentários Finais:O Pseudocisto pancreático representa uma complicação TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS importante da pancreatite,que requer abordagem CÓDIGO: 87929 cirúrgica, quando não regride espontaneamente.O caso apresentado,evoluiu de forma favorável, devido ao RELATO DE CASO: CARCINOMA PANCREÁTICO acompanhamento e condutas adequadas. PÓS PANCREATITE Contato: Marcelo Vieira Gissoni de Carvalho Autores: Franco Antônio Cordeiro Neves / Neves,F.A.C. [email protected] / Complexo Hospitalar São Francisco de Assis ; Amanda Cristina Torres Martins Bicalho / Bicalho,A.C.T.M. / Complexo Hospitalar São Francisco de Assis; Marcelo TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS Vieira Gissoni de Carvalho / Carvalho,M.V.G. / Complexo CÓDIGO: 88380 Hospitalar São Francisco de Assis; David Andres Bravo Martinez / Martiez,D.A.B. / Complexo Hospitalar São RESSECÇÕES HEPÁTICAS EXPERIÊNCIA DE UM Francisco de Assis; Danilo Esteves Pires Filho / Filho,D.E.P. / Complexo Hospitalar São Francisco de Assis; Priscilla Dias CENTRO ONCOLÓGICO DO CENTRO OESTE Silva / Silva,P.D. / Complexo Hospitalar São Francisco de Autores: Rayane Marques Cardoso / Cardoso, RM / Assis; Marcelo Gomes Girundi / Girundi, M.G. / Complexo HOSPITAL ARAUJO JORGE; Marcel Shono / Shono M / araujo
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jogrge; Jordana Botelho / JORDANA BOTELHO / HOSPITAL / Massutti, A. M. / Hospital Santa Isabel; Thayla ARAUJO JORGE; Alexandre Menezes de Brito / ALEXANDRE Valderrama Bicheri / Bicheri, T. V. / Hospital Santa MENEZES DE BRITO / HOSPITAL ARAUJO JORGE. Isabel; Nathalia Luiza Ferri Bonmann / Bonmanni, N. L. F. / FURB; Mauro Rafael da Igreja / Igreja, M. R. / Hospital Introdução: O conhecimento anatômico e o domínio Santa Isabel; Bruno Menega / Menega, B. / FURB; Joao vascular relacionadas às ressecções hepáticas evoluíram Francisco Petry / Petry, J. F. / Hospital Santa Isabel; e desenvolveram para a padronização e melhoria Leonardon Getulio Piovesan / Piovesan, L. G. / FURB; cirúrgica. O fígado é sítio de diversas metástases, João Victor Mendes / Mendes, J. V. bem como neoplasias primárias, e a ressecção no manejo das neoplasias malignas tem sido descritas Pancreatic cancer is a disease with high lethality and poor há mais de 60 anos. O conhecimento das técnicas prognosis due in part to being a silent neoplasm until it cirúrgicas, dos cuidados perioperatorios e intensivos reaches advanced stages. With the evolution of anesthetic no pós operatório contribuíram para baixas taxas de control, perioperative management and operative mortalidade e morbidade Para metástases colorretais techniques, duodenopancreatectomy, the only curative a abordagem hepáticas se reflete em um aumento na technique for periamolar neoplasia, could be performed sobrevida, entretanto para outros sítios primários, more safely, with mortality below 2% and morbidity resultados favoráveis, podem ser obtidos pela escolha between 10-15% among current epidemiological indices. selecionada do paciente para o procedimento cirúrgico. The incidence of postoperative complications remains Objetivo: O objetivo deste estudo é conhecer e divulgar high, between 30-61%. The objective of this study is the os resultados obtidos das ressecções hepáticas neste retrospective analysis of duodenopancreatectomies centro de referência. Materiais e métodos: Foram performed at the services of Hospital Santa Isabel, coletados dados do referentes as todos tipo de ressecção Blumenau - SC, from February 2018 to May 2019, hepática entre os meses de maio de 2017 a dezembro totaling 18 patients. In addition to direct comparison with de 2018. Resultados: Foram realizado 38 cirurgias de international epidemiological data and the profile of the ressecção hepáticas no período mencionado A amostra patients studied, we performed a bivariate comparative foi composta de 23(60,52%) pacientes do sexo feminino, analysis: between surgical time as an independent 15( 39,47%) do sexo masculino. A média de idade foi de risk factor for the development of complications; 56,38 anos de idade, sendo o mais jovem de 26 anos e between the type of surgical reconstruction and the o paciente mais idoso de 80 anos. Dentre os resultados development of complications. The technique chosen anatomopatológicos, dois foram benignos- adenoma; for duodenopancreatectomy was performed within 13 (34,21%) indicações foram por tumores colorretais; the standard practice of Brazil. Portal vein resection apenas 1 caso de hepatocarcinoma, 4 ressecções foram was required in one patient due to tumor invasion. The realizadas por laparoscopia E o US intraoperatório foi pancreatic anastomosis performed was pancreatojejunal utilizado em 8 procedimentos do total. Hepactectomias type, after insertion of urethral tube into the pancreatic duct segmentares (28.9%) e as metástasectomias (26,31%) and ductomucous anastomosis. Next, the biliodigestive foram os procedimentos mais realizados; hepatectomia anastomosis 15cm from the pancreatic anastomosis and direita realizado em 5 pacientes A ressecção R0 foi gastroenteroanastomosis in the posterior gastric wall was alcançada em 37 dos procedimentos . ALPPS foi realizada performed with Bilroth II reconstruction in 3 patients and em 1 caso. Discussão A evolução nas técnicas operatórias Roux Y in 15 patients. The need for blood transfusion in e a melhoria nos cuidados capacitou procedimentos the peri- and postoperative period was recorded. The com morbidade e mortalidade aceitáveis. A Indicação operative time was also analyzed. It was also recorded the de pequena quantidade de neoplasias de tumores number of days of hospitalization, besides the amylase colorretais observada em nossa amostra se deva a of the drain in the 1st and 3rd postoperative days. The incompletude dos prontuários e dados compilados. histopathological diagnosis was confirmed by the analysis Tempo cirúrgico, sangramento intraoperatório e of the fixed surgical specimen. Postoperative death is complicações, não são encontrados de maneira habitual considered to be death up to 30 days after surgery. na descrição cirúrgica. Ainda com a ausência de alguns Pancreatic duodenopancreatectomy is still associated dados mostra-se o impacto e potencial, bem como a with high morbidity, but it is still the only solution for elevada quantidade de ressecções realizados em um peri-ampolar pancreatic neoplasia. With adequate serviço de referência, fato que aumenta a expertise e selection of patients undergoing TDP and intensification melhora do prognóstico dos pacientes operados. of postoperative care, this procedure can be performed more safely and with longer survival. Contato: Rayane Marques Cardoso [email protected] Contato: Ana Carolina Bathelt Fleig [email protected]
TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS CÓDIGO: 87709 TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS CÓDIGO: 87707 RETROSPECTIVE COORT: EPIDEMIO-ONCO- LOGICAL ANALYSIS OF DUODENOPANCRE- RIGHT HEPATECTOMY FOR TREATMENT OF ATECTOMIES AND THEIR OUTCOMES AT HEPATOCELLULAR ADENOMES IN HOSPITAL SANTA ISABEL HOSPITAL IN 2018-2019 SANTO ANTONIO Autores: Ana Carolina Bathelt Fleig / Fleig, A. C. B. Autores: Ivan Tadeu de Mendonça Junior / / Hospital Santa Isabel; Andrew Maicon Massutti MENDONÇAJR,IT / HSA; Daniel Neves Queiroz / NEVES,DQ
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/ HSA; Luana Dib de Mendonça / MENDONÇA,LD / Porto Dias; Henrique Acácio Barbosa / Barbosa, H. A. UNICID. / Hospital Porto Dias; Fábio Sales Frota / Frota, F. S. / Hospital Porto Dias; Ruan Gabriel Pinho Botelho dos Objective: To report the case of the treatment of Santos / santos, R. G. P. B / Hospital Porto Dias; Eduardo benign liver tumor treatment at the santo antonio Duarte Espíndola / Espíndola, E. D. / Hospital Porto Dias. hospital evaluating its evolution with the current recommendations for the approach of these Pancreatic neoplasia is the second in the pathologies. Method: Patient m.A.Q.M., 41 Years, from gastrointestinal tract and the fourth cause of seberi-rs, brought to the special ambulatory of the santo lethality on a global scale. Pancreatic cancer is often antonio de tenente portela / rs hospital referred to right associated with a poor prognosis, highlighted by hypocondry initial three months, having performed the close parallel between incidence and mortality. a usg of total abdome which evidentiated collelitiasis Pancreatectomy duodenopancreatectomy or and hepatic mass claring into the right wolf. To global gastroduodenopancreatectomy (Whipple‘s surgery) abdome examination without a tasty pasta, surfaceful remains the main curative treatment option for pain. Obese, anicterica, history of oral conceptual use pancreatic head cancer. Survival remains low, between for 25 years. In treatment for diabetes for 10 years 5% and 20%, and related to several factors - most with oral hypoglycemants. Further requests for hepatic importantly considering the late stage in which neoplasia investigation with the following findings: most patients are diagnosed. Retrospective cohort tumor markers (cea; alpha feto protein and ca 19.9) study using medical records of patients submitted All normal. Eda showing only light gastrite. Normal to duodenopancreatectomy in a referral hospital for colonoscopy. High abdome mri not performed due to a period of 3 years. There was prevalence in men in fobia frame (sic). Made of chest and ct tomography of an average age of 55.8 years, whose most prevalent abdome and pelvis where it was observed presence of sign was jaundice. More than 70% underwent a mixed image with subscripular increased cellularity, gastroduodenopancreatectomy, with single-loop soft part coefficients, measuring 19,2x18,3x13,7cm. telescopic pancreatic anastomosis, although surgical With its solid portion measuring 10.8X8.8X10.7Cm morbidity is within acceptable range, but mortality is according to right hepatic wolf with commitment still high when compared to large referral centers. of segments v to viii normal thorax tomography. Percutaneous punction was contraindicated due to the Contato: Marcela Carvalho de Queiroz risk of bleeding in the extensive subcapsular collection. [email protected] Due to the large proportions and characteristics of the suggestive hepatic mass adenoma and in accordance with the consensus guidelines of the european living TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS study association (easl), the surgical approach for the CÓDIGO: 87368 patient submitted to classic right hepatectomy with tactical collecystectomy. Remained three days in the icu SURGICAL RESECTION FOR PANCREATIC with great clinical evolution. High hospital activities on MALIGNANT DISEASES THE EXPERIENCE OF the fifth post-operative day in great clinical conditions and is in lator both monitoring.Conclusion: The good THE FEDERAL UNIVERSITY OF UBERLANDIA post-operative clinical evolution. Injury aspects and ONCOLOGYS DEPARTMENT compatible risk factors with hepatocellular adenoma Autores: Rafael Sousa Santos / Santos, R. S. / with high risk of bleeding percutaneous biopsy Universidade Federal de Uberlândia; Tsbco Paulo corroborate and validate recommendation for surgical Henrique de Sousa Fernandes / Fernandes, P. H. S. approach to hepatocellular adenomas bigger than 5cm. / Universidade federal de Uberlândia; Tsbco Michel These injuries should be dried out because of the big Jamil Chebel / Chebel, M. J. / Universidade federal de risk of blooding and malignizing them. Uberlândia; Tsbco Marcelo Augusto Faria de Freitas / Freitas, M. A. F. / Universidade federal de Uberlândia; Contato: Ivan Tadeu de Mendonça Junior Gabriel Borges Barbosa / Barbosa, G. B. / Universidade [email protected] federal de Uberlândia.
The pancreatectomy is a surgery procedure that TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS historically carries risk and serious complications. CÓDIGO: 88161 In the experience of the Oncology department of the Universitary Hospital including 38 patients with SURGICAL APPROACH TO PERIAMPULAR malignant and benign lesions, the surgical and post TUMORS operatives aspects are reported and related to the length of stay and survival. Between 2015 and 2019, 38 Autores: Raíssa Pereira de Tommaso / Tommaso, R. P. patients, with a median age of 55 years (29 to 80 years) / Hospital Ophir Loyola; Patrícia Isabel Bahia Mendes underwent pancreatic resection or palliative surgery Freire / Freire, P. I. B. M. / Hospital Ophir Loyola; approaches, 23 patients with periampular tumors, 12 Marcos de Souza Lopes Freire Filho / Freire Filho, M. with adenocarcinomas, 8 with papilla neoplasms, 3 S. L. / Hospital Ophir Loyola; Bruno Dourado Kovacs with neuroendocrine tumors and 1 with inflammatory Machado Costa / Costa, B. D. K. M. / Hospital Ophir tumors due to chronic pancreatitis. Whipple resection Loyola; Marcela Carvalho de Queiroz / Queiroz, M. C. was applied in 17 patients , distal resection with / Hospital Metropolitano de Urgência e Emergência; splenectomy in 4 and biliodigestive shunt in 5 patients. Ana Caroline Sobrinho Dias / Dias, A. C. S. / Hospital The mean operative time for resections of malignant
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neoplasms was 5 hours and 20 minutes and for wall, duodenal arch, and colon. The lesion had lobulated other surgeries of 2 hours and 50 minutes. The need contours measuring about 9.5 x 12.8 cm along its longest for intraoperative blood transfusion occurred in 8 longitudinal and transverse axes, respectively. Due to cases, with an average of 3.75 units of red blood cell the tumor size, it opted for neoadjuvant chemotherapy concentrates. A single intraoperative death occurred. with Cisplatin and Gemzar for 04 cycles. After the end Postoperative length of stay ranged from 3 to 47 days of treatment, new comparison tests were performed, for pancreatectomies (from 5 to 47 days for Whipple), which showed persistent lesion, although smaller, and from 2 to 27 days for other surgeries. Staging by measuring about 9.1 x 10.7 cm. Surgery was indicated, pathological anatomy showed 12.5% at T1; 16.6% with partial hepatectomy with cholecystectomy, a in T2; 45.8 in T3 and 25% T4. Regarding lymph node partial colectomy, partial gastrectomy, retroperitoneal involvement 45.8% N0; 41.6% N1; and 4% N 2. Clinical lymphadenectomy with Billroth II reconstruction follow-up indicated adjuvant chemotherapy in 10 cases and colostomy. The pathology revealed moderately and only 1 patient received radiotherapy. Among the differentiated gallbladder adenocarcinoma and patients included in the study, 39% died in the period free margins. During the postoperative period, up to July / 2019. Among deaths, 40% occurred within 6 she developed deep surgical wound infection and months after surgery; 33.3% between 6 months and 1 hospitalized for 18 days. Discussion: Gallbladder year; 20% between 1 and 2 years; 6.6% over 2 years. The cancer is rare but has a high malignant potential. remaining patients have outpatient follow-up, with the Most cases are diagnosed incidentally during interval between the last consultation and surgery of up cholelithiasis investigation, often in advanced stages, to 6 months at 29.4%; between 6 months and 1 year contraindicating surgery, which is the only therapeutic in 23.5% and over 1 year in 47%. Even with increasing possibility of the disease. Thus, patients with locally advances, surgery remains the only curative treatment. advanced or borderline adenocarcinoma may benefit However, most patients have advanced or unresectable from neoadjuvant chemotherapy to reduce the tumor disease due to extensive local vascular involvement and and then resect the lesion for therapeutic purposes, as the presence of distant metastases. Surgery candidates in the case cited above. Final considerations:Patients have to be prepared for a major procedure that still with locally advanced gallbladder adenocarcinoma carries morbidity and mortality risks. should be considered for neoadjuvant chemotherapy, seeking to regress the disease and perform curative Contato: Rafael Sousa Santos surgery R0. [email protected] Contato: Barbara Paulo Cavalcante [email protected] TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS CÓDIGO: 87926 TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS TREATMENT OF GALLBLADDER CARCINOMA CÓDIGO: 87432 WITH ASSOCIATION BETWEEN NEOADJUVANT CHEMOTHERAPY AND SURGERY: A CASE TUMOR NEUROENDÓCRINO DE PÂNCREAS: REPORT RELATO DE CASO Autores: Mohamad Read Ali Tayeh / Tayeh, M. R. A. / Autores: Barbara Paulo Cavalcante / Cavalcante, B. P. Hospital e Maternidade Marieta Konder Bornhaunsen; / Universidade Potiguar; George Alexandre Lira / Lira, Gabriela Aparecida Schiefler Gazzoni / Gazzoni, G. A. G. A. / Liga Norte Riograndense Contra o Câncer; André S. / Universidade do Vale do Itajaí; Isabella de Oliveira Luiz Costa e Silva / Silva, A. L. C / Universidade Federal / Oliveira, I. / Universidade do Vale do Itajaí; Bárbara do Rio Grande do Norte; Amanda Barbetto Medeiros Wiese / Wiese, B. / Universidade do Vale do Itajaí; Torres / Torres, A. B. M. / Universidade Potiguar; Vanessa Vizentin / Vizentin, V. / Universidade do Vale do Marina Fernandes / Fernandes, M. / Universidade Itajaí; Gustavo Tenfen / Tenfen, G. / Hospital do Coração; Potiguar; Renata Beatriz Bessa Teixeira / Teixeira, R. Gustavo Galvan Debiasi / Debiasi, G. G. / Universidade B.B. / Universidade Potiguar; Víctor José Negreiros de do Vale do Itajaí. Sá Rosado / Rosado, V. J. N. S / Universidade Potiguar; Pedro de Albuquerque Mafaldo / Mafaldo, P. A. / Universidade Potiguar; Juliana Maria Caetano Nogueira Descrição do caso: S.L.C., masculino, 63 anos, relata / Nogueira, J. M. C / Universidade Potiguar. ter um exame de imagem de 2015 que evidenciou nódulo em cabeça de pâncreas e evoluiu para icterícia no mesmo ano, procurando atendimento. Em um Case Report: M.A.B.O., a 59-year-old woman, serviço especializado, foi realizada colecistectomia e presented chronic anemia, upper abdominal pain colecistojejunoanastomose. Sugerido embolização, no with a gastrointestinal disorder, no other significant momento, mas negada por se tratar de um possível complaints. Physical examination revealed a palpable hemangioma. Em 2017, após colangites de repetição, mass in the right upper quadrant with limited mobility iniciou investigação de nódulo hepático. Tomografia and intimate contact in the hepatic region. She computadorizada (TC) de tórax e abdome de 03/19 performed some imaging exams such as computerized mostrou nódulo calcificado em base pulmonar direita tomography and magnetic resonance imaging with e massa sólida expansiva em cabeça de pâncreas, findings of extensive heterogeneous expansive de aspecto heterogêneo e associada a necrose, formation with signs of central necrosis, compromising progredindo para a região do hilo hepático, medindo the inseparable hepatic ventral surface of the cerca de 13,0 cm x 13,0 cm. Ainda, houve presença de gallbladder that has calculi inside and also the gastric
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linfonodomegalias retroperitoneais, medindo 4,0 cm. O hepático e linfadenomegalia periportal, correspondendo PET-CT realizado confirmou lesão retroperitoneal, com aos achados intraoperatórios de tumor hepático em elevada expressão de receptores de somatostatina. segmento VI, massas retroperitoniais e acometimento Estudo imuno-histoquímico da lesão evidenciou linfonodal. À análise histopatológica confirmou-se neoplasia endócrina pancreática de células claras e o disseminação do tumor pancreático pseudopapilífero. Ki67 foi inferior a 2%, sendo a neoplasia classificada Após tratamento cirúrgico, a paciente encontra-se sem de baixo grau. Até o presente momento, o paciente evidências da doença. Discussão: O tumor de Frantz é assintomático e não apresenta mais quadros de é uma neoplasia rara do pâncreas, um tumor sólido icterícia. Com a recidiva de colangite, optou-se pelo pseudopapilar, com maior incidência em mulheres uso de levofloxacino profilático. O mesmo segue com jovens na terceira década de vida. A maior parte desses proposta do uso de terapia alvo ou quimioterapia. tumores possui baixo grau de malignidade e em geral Discussão: Os tumores neuroendócrinos pancreáticos o prognóstico é bom após a ressecção cirúrgica. As (TNE-P) são considerados neoplasias indolentes, as manifestações clínicas mais comuns são a presença quais representam 1 a 2% das neoplasias pancreáticas. de massa abdominal palpável ou dor abdominal Dividem-se em tumores funcionais e os não funcionais, inespecífica. A maioria dos diagnósticos de casos do os quais correspondem a 70% dos casos e são Tumor de Frantz é de forma incidental, sendo que estes assintomáticos em sua grande maioria. Ainda, podem podem ser confirmados através de exames de imagem. ser classificados de acordo com a agressividade Determinar critérios histopatológicos preditivos de tumoral, sendo os de baixo grau mais indolentes, dado agressividade do tumor ainda é complexo devido a que condiz com o quadro clínico do paciente, o qual raridade do tumor, além da longa história natural da apresenta uma doença arrastada. Apesar dos exames doença. Apenas em aproximadamente 15% dos casos de imagem serem importantes, a abordagem cirúrgica houve potencial maior de malignidade em virtude de permanece como a terapia de escolha para pacientes metástases para gânglios, peritônio e órgãos distantes. com TNE-P ressecáveis. No entanto, a seleção para o A presença de invasão venosa, atipia nuclear e áreas tratamento cirúrgico deve avaliar a funcionalidade do de necrobiose nesses casos sugerem que tais achados tumor, grau, estadiamento e comorbidades associadas. podem predizer uma forma de doença avançada. A Conclusões finais: Os tumores neuroendócrinos sobrevida relatada é de 7 10 anos, em pacientes com gastroenteropancreáticos são de manejo desafiador, ressecção completa da lesão e também naqueles com pois representam uma família heterogênea de doença residual. Comentários finais: Trata-se de um neoplasias. Embora o crescimento e progressão caso raro com metástases à distância com tratamento da maioria desses tumores sejam lentos, não é cirúrgico e sobrevida de mais de 10 anos em bom infrequente a ocorrência de metástases. A produção estado de saúde. Desta forma, o tratamento cirúrgico hormonal, a multiplicidade de lesões hepáticas e o implantado culminou em um desfecho favorável, comprometimento da função hepática agravam o oferecendo um excelente prognóstico para a paciente. prognóstico. Contato: Marcílio Lisboa Vital Contato: Mohamad Read Ali Tayeh [email protected] [email protected]
TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS TEMÁRIO: TUMORES HEPATOBILIOPANCREÁTICOS CÓDIGO: 87655 CÓDIGO: 88308 VIPOMA IN AN ELDERLY PATIENT: A CASE TUMOR SÓLIDO PSEUDOPAPILAR DE REPORT PÂNCREAS: UM CASO RARO DE METÁSTASE Autores: Pedro Pinheiro Bezerra de Meneses / Meneses, HEPÁTICA E RETROPERITONEAL P. P. B. / Hospital Universitário Otávio de Freitas; Maria Autores: Marcílio Lisboa Vital / Vital, M. L. / Fundação Amanda Londres Lopes Pinheiro / Pinheiro, M. A. L. L. São Francisco Xavier ; Juliane Caroline Apinharíeis / Faculdade Pernambucana de Saúde; Parisina Fraga Rocha / Rocha, J. C. P. / Instituto Educacional Vale do Dutra Cabral de Carvalho / Carvalho, P. F. D. C. / Hospital Aço - UNIVAÇO; Luísa Viana de Almeida / Almeida, L. São Paulo - UNIFESP. V. / Instituto Educacional Vale do Aço - UNIVAÇO; Ana Carolina Bhering de Carvalho Costa / Costa, A. C. B. Case Report: 68 year-old patient with a previous medical C. / Hospital Israelista Albert Einstein; Ana Carolina history of hypertension and diabetes presented to the Vale Campos Lisboa / Lisboa, A. C. V. C. / Instituição E.R with watery diarrhea that had started a month prior. Educacional do Vale do Aço - UNIVAÇO. Currently on day two of antibiotic course Ciprofloxacin + Metronidazol without improvement. On arrival, patient Apresentação do caso: Apresenta-se um caso raro de was severely dehydrated. Test results indicated BUN metástase hepática e retroperitoneal de tumor sólido 183mg/dL, creatinine 6,2mg/dL, HCO2 11 mEq/L, K+ pseudopapilar (tumor de Frantz). Trata-se de paciente 3,1 mEq/L. Patient continued to present with diarrhea jovem, sexo feminino, em acompanhamento clínico after ICU admission, developing metabolic acidosis and há 10 anos após tratamento cirúrgico com ressecção uremic syndrome despite aggressive fluid replacement tumoral e pancreatectomia corpo-caudal. Ainda que therapy, which prompted the need for hemodyalisis. incomum a disseminação desse tipo de tumor em Due to the persistence of secretory diarrhea without an órgãos próximos ou a invasão de vasos, a ressonância apparent organical substract, as well as the development magnética associada a PET-TC evidenciaram nódulo of hypokalemia (2,3 mEq/L), the diagnosis of VIPOMA
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was pursued. Additional tests revealed Chromogranin A in supraclavicular cervical lymph node metastasis D. levels and two enhanced pancreatic lesions were seen Patient evolving with clinical worsening, presenting using PET-CT 68-Ga DOTATATE. Therapy with octeotride symptoms such as dyspnea and being evaluated the improved symptoms. The patient underwent distal progression of the disease even with QT chosen by pancreatectomy and splenectomy. The histopathological palliative conduct. Discussion: Glioblastoma (GBM) report was positive for VIPOMA, stage TNM pT3N0M0. has a high mortality rate: only 5% of individuals who Patient was discharged home 8 days after the procedure have the disease survive in 5 years. Due to the several without complications. Literature review: Vipoma is a studies of chemotherapy and radiotherapy treatments rare pancreatic neuroendocrine tumor associated with developed, the prognosis of this neoplasia has excessive secretion of vasoactive intestinal polypeptide improved, but still remains gloomy. This is partly due to (VIP), leading to a syndrome of watery diarrhea and its aggressive character with rapid growth and invasion, characteristic electrolyte abnormalities. Its incidence and partly due to relapses that occur in 40% of cases. is of 1 in 1 million per year, most commonly during Protocols like Stupp‘s (radiotherapy and six adjuvant the fourth decade. 60-80% of patients present with temozolomide cycles), used in the case of the patient metastatic disease. Chronic watery diarrhea is seen in in this report, are part of the new protocols, increasing 98% of cases, followed by hypochlorhydria (75%) and survival by 2-fold. Most relapses develop locally, and hypokalemia (66%). Acute kidney injury is the main cause when they do not affect the brain, they settle in bones, of mortality amongst these patients. Diagnosis can be lymph nodes and lungs, resulting from the forms of made on clinical grounds and additional exams. Serum distant dissemination of GBM: vascular and lymphatic. VIP concentrations higher than 75pg/mL are highly It is a rare event, occurring in only 0.4% of patients, suggestive. In the present case the dosage of vasoactive which seems to be explained by the containment effect intestinal peptide was not available, however there exerted by the dura mater and the blood-brain barrier. have been reports of normal levels in between diarrheal Other factors that determine the rarity of distant episodes. Imaging studies are crucial in helping locate relapses are the age of the patient (they are common and determine the size of the tumor. PET-CT 68-Ga in young patients, such as the patient in the report, but DOTATATE has become increasingly popular due to its most affected are elderly) and the speed of invasion high sensibility and ability to locate smaller lesions and and tumor growth (death occurs before metastasis is extra-abdominal metastatic disease. It can also predict installed). the response to clinical treatment with octeotride. The definitive treatment is surgical. Final considerations:In Contato: Guilherme Vilela Tapparo spite of its rare nature, VIPOMAS should be suspected [email protected] given the high survival rates associated with early diagnosis. TEMÁRIO: TUMORES TORÁCICOS Contato: Maria Amanda Londres Lopes Pinheiro CÓDIGO: 87876 [email protected] CLASSIFICATION AND EPIDEMIOLOGICAL PROFILE OF MEDIASTINAL TUMORS CASES TEMÁRIO: TUMORES TORÁCICOS CÓDIGO: 88342 IN A REFERENCE HOSPITAL OF THE PUBLIC HEALTH SERVICE IN SALVADOR-BA CASE REPORT OF GLIOBLASTOMA WITH Autores: Caenna Corrêa e Correia / Correia, C. C. / LYMPHONODE SUPRACLAVICULAR RIGHT FMB/UFBA ; Iguaracyra Araujo / Araujo, I. / FMB/UFBA; METASTASE Rogério Almeida Moreno Santos / Santos, R.A.M. / FMB/ UFBA. Autores: Guilherme Vilela Tapparo / Tapparo,G.V / Hospital do Câncer Araújo Jorge; Frederico Pereira Introduction: Mediastinal tumors include several Monteiro / M,F.P / Hospital do Câncer Araújo Jorge; histological types with distinct biological behaviors. Ricardo Restivo de Castro Teixeira / T,R.R.C / Hospital These subtypes vary with age, with thymic tumors being do Câncer Araújo Jorge; Luciana Benevides de Araújo / the most common, followed by lymphomas, neurogenic A,L.B / Hospital do Câncer Araújo Jorge; Lauana Vanessa tumors, germinative cells tumors and cysts. Background Santos Maurício / M,L.V.S / Hospital do Câncer Araújo / Objective: Considering the lack of data on these Jorge; Luiza Carneiro Bertazzi / B,C.L / Hospital do tumors in our country, we decided to describe a series of Câncer Araújo Jorge; Thais Franco Simionatto / S,F.T / 122 consecutive cases of mediastinal tumors according Hospital de Câncer de Barretos. to histological type, age and gender. Methodology: a descriptive epidemiological study based on Case Presentation: A 36-year-old male patient with a anatomopathological and immunohistochemical large expansive / infiltrative lesion affecting the entire diagnoses from 2009 to 2016, in mediastinal topography, temporal lobe and almost all of the left occipital lobe. in a referral hospital for cancer treatment in Salvador- Evaluated by neurosurgery that indicated surgical Bahia. It was made Excel® spreadsheet database. resection of the lesion with postoperative adjuvant Results: A total of 122 patients were identified, 66 men therapy. Radiotherapy (RT) 3D indicated 30 sessions of and 56 women, with a mean age of 40 years (SD +/- 19). 200cgy each + chemotherapy (QT) with temodal 420mg Of the 122 tumors, 7 were non-neoplastic cysts and 5x. After the end of RT and QT started the follow up. 115 were neoplasms. Among the neoplasms, 99 (86%) After 2 years of follow-up due to GBN operated after were malignant and 16 (14%) benign. Lymphomas were adjuvant therapy evolving with recurrence of disease the most common malignant neoplasms (44 cases,
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44.4%), followed by carcinomas (22, 22.2%), germinative synaptophysine, but negative for cytokeratin (which cells tumors and other rare ones. Lymphomas and is positive for carcinoids). According to the literature, carcinomas were more frequent in males (41 men, only 24 cases have been described, of which only 62.1%, and 25 women, 37.9%), while benign thymomas one in Brazil. Final comments: The primary lung and neural tumors were more frequent in females (9 paraganglioma has been questioned for many years. men, 32.1%, and 19 women, 67.9%). Conclusion: There Currently they represent 1% of the paragangliomas is a clear difference in the histopathological pattern of and can be confused with carcinoid tumors, being mediastinal tumors regarding age and gender, being immeasurable the help of immunohistochemistry to the most common benign tumors in female patients. corroborate the definitive diagnosis. Patient follow-up Neuroblastic malignant tumors were exclusive to the is necessary due to the possibility of metastases (there pediatric group, while carcinomas were exclusively is no method to distinguish malignant from benign observed in adults. The high frequency of mediastinal paragangliomas) with the aid of urinary catecholamine lymphomas is highlighted, including a rare subtype analysis and imaging studies. for this topography, Burkitt lymphoma, requiring correlation with possible risk factors. Contato: Adriano Eduardo Costa de Figueiredo [email protected] Contato: Caenna Corrêa e Correia [email protected] TEMÁRIO: URO ONCOLOGIA CÓDIGO: 88374 TEMÁRIO: TUMORES TORÁCICOS CÓDIGO: 87289 A CASE REPORT OF BLADDER MELANOMA Primary Lung Paraganglioma: Case Report Autores: Daniel Carvalho Ribeiro / RIBEIRO, D. C . / HOSPITAL DO CÂNCER DE MURIAÉ - FUNDAÇÃO Autores: Adriano Eduardo Costa de Figueiredo / CRISTIANO VARELLA; Thaís Regina Valente de Sousa FIGUEIREDO, A.E.C. / Instituto Nacional de Câncer (INCA); / SOUSA, T. R . / HOSPITAL DO CÂNCER DE MURIAÉ - Erlon de ávila Carvalho / CARVALHO, E.A. / Instituto FUNDAÇÃO CRISTIANO VARELLA; Abilio Castro Almeida Nacional de Câncer (INCA); Andréia Salarini Monteiro / / ALMEIDA, A.C . / HOSPITAL DO CÂNCER DE MURIAÉ MONTEIRO, A.S. / Instituto Nacional de Câncer (INCA); - FUNDAÇÃO CRISTIANO VARELLA; Pedro Ribeiro Mota Teresa Cristina Ferreira Gutman / GUTMAN, T.C.F. / / MOTA, P. R . / HOSPITAL DO CÂNCER DE MURIAÉ Instituto Nacional de Câncer (INCA); Aureliano Mota - FUNDAÇÃO CRISTIANO VARELLA; Rafael Miranda Cavalcanti de Sousa / SOUSA, A.M.C. / Instituto Nacional Oliveira / OLIVEIRA, R. M . / HOSPITAL DO CÂNCER DE de Câncer (INCA). MURIAÉ - FUNDAÇÃO CRISTIANO VARELLA; Bruno de Oliveira Pacheco / PACHECO, B. O . / HOSPITAL DO Case Report: Female pacient, 56-year-old, smoker (63 CÂNCER DE MURIAÉ - FUNDAÇÃO CRISTIANO VARELLA; pack-years) started in March 2013 with pneumonia Jason Lucas Sales Junior / JUNIOR, J. L . / HOSPITAL being treated with levofloxacin. There was no clinical DO CÂNCER DE MURIAÉ - FUNDAÇÃO CRISTIANO improvement and worsening cough. Chest CT VARELLA; Maria Fernanda Botelho Teixeira / TEIXEIRA, showed middle lobe atelectasis without mediastinal M. F . / HOSPITAL DO CÂNCER DE MURIAÉ - FUNDAÇÃO adenomegaly (Figure 1). Bronchoscopy showed a CRISTIANO VARELLA; Edson Augusto Prachia Ribeiro vegetative endobronchial tumor, friable with occlusion / RIBEIRO, E. A . / HOSPITAL DO CÂNCER DE MURIAÉ - of the middle lobe bronchus whose biopsy was FUNDAÇÃO CRISTIANO VARELLA; Ithalo Henrique Alves compatible with a carcinoid tumor (Figure 2). It was Pereira / PEREIRA, I. H . / HOSPITAL DO CÂNCER DE in good general condition, with performance status 1. MURIAÉ - FUNDAÇÃO CRISTIANO VARELLA. Spirometry allowed even right pneumonectomy and cardiac evaluation showed no change. On November Attended at the uro-oncology ambulatory, R.R.B., 55 21, 2013, the patient underwent a conventional middle years old woman, complaining of hematuria for four lobectomy. The postoperative period was uneventful months; brought an ultrasound examination of the and she was discharged in the 3rd postoperative. In urinary tract showing a lesion on the 4.8cm bladder the analysis of the surgical specimen, it was concluded floor. The patient has gone through abdominal/pelvic that the lesion was a primary lung paraganglioma. This tomography, which evidenced a 7.0 cm vegetative diagnosis was confirmed by immunohistochemistry: formation in the bladder floor, infiltrating the left JUV chromogranin positive, S100 positive in support cells, and an 1.0 cm adrenal nodule with a probable diagnosis Ki67 <2% and CAM 5.2 negative (Figure 3). Currently, she of adenoma. The patient underwent transurethral has outpatient follow-up and no evidence of disease resection of the bladder in January 2017 with a large (Figure 4). Discussion: Extra-adrenal paragangliomas, infiltrate-like sessile lesion found on the left bladder rare tumors originating from neuroectodermal floor, which was incomplete due to the volume of the paraganglia, occur mostly in the para-aortic region, lesion. Histopathology admitting undifferentiated specifically in areas close to the carotid body and malignant neoplasia with immunohistochemistry, mediastinal vein. Pulmonary paragangliomas represent positive for S100 and Melan A, compatible with the about 1% of all paragangliomas. They appear as solitary diagnosis of melanoma. Patient then underwent and mostly asymptomatic tumors, predominating in dermatological examination by dermatologist, females and middle-aged patients. They are composed ophthalmic examination, EDA and colonoscopy, all of cell types arranged in a diffuse arrangement with normal findings. CT of skull, thorax, abdomen and throughout the tumor called Zellballen. Paraganglioma pelvis without addition. Then definitive retrospective is positive for chromogranin A, antiprotein S100 and diagnosis of primary bladder melanoma; performed
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May 2017 radical cystectomy and Bricker reconstruction. hospitalization. Nationally, a mortality rate in the same Started June 2017 by clinical oncology, adjuvant with period is 0.37 and the average hospitalization days is Interferon. During follow-up, the patient evolved with 6 days.Despite having its entries within the region, the a left adrenal mass of 7.0 cm in November 2018. She surgical scenario has positive outcomes and is a very underwent video-assisted adrenalectomy surgery in effective alternative, with rates and numbers related to January 2019. Histopathology of the piece confirming mortality and survival increasing with the passage of metastatic melanoma. years.
Contato: Thaís Regina Valente de Sousa Contato: Daniel Mendonça de Almeida [email protected] [email protected]
TEMÁRIO: URO ONCOLOGIA TEMÁRIO: URO ONCOLOGIA CÓDIGO: 88360 CÓDIGO: 85718
ANALYSIS OF THE PUBLIC SCENARIO OF THE CARCINOMA OF SMALL BLADDER CELLS, RARE SURGICAL APPROACH TO PROSTATE CANCER AND AGGRESSIVE TUMOR: CASE REPORT IN AN AMAZONIAN CAPITAL Autores: Elane Frota Aragão / Aragão,E.F / Autores: Afonso Moraes Melo Júnior / Júnior, A.M.M. Universidade Nilton lins; George Lins de Albuquerque / / Centro Universitário do Pará; Daniel Mendonça de Albuquerque,G.L. / fametro/Fundação cecon; Elia Frota Almeida / Almeida,D.M. / Universidade Federal do Aragão / Aragão,E.F. / Universidade Fametro; Eduarda Pará; Hendy Sheiijy Taniyama Dantas / Dantas,H.S.T. / Gabrielly da Costa Rodrigues / Rodrigues,E.G.C. / Universidade Federal do Pará; Raíssa Souza de Oliveira Universidade Nilton Lins; Larissa Pereira Duarte / / Oliveira,R.S. / Universidade Federal do Pará; Luiz Felipe Duarte,L.P. / Universidade Fametro; Juliana Gomes Macena de Avelar / Avelar, L.F.P. / Universidade Federal Frota / Frota,J.G. / Universidade Fametro; Ana Cláudia do Pará; Maria Luíza Alves Cobiniano de Melo / Melo, Ferraz Afonso / Afonso,A.C.F. / Universidade Fametro; M.L.A. / Universidade Federal do Pará; Thalita da Rocha Louise Trindade Moreira / Moreira,L.T. / Universidade Bastos / Bastos, T.R. / Universidade do Estado Pará. Fametro; Barbara Albuquerque Bentes / Bentes,B.A. / Universidade Fametro; Vinícios Diniz / Diniz,V. / Prostate cancer is the second most common male in Fundação cecon. Brazil. In 2018, there are 68,220 new cases registered. Diagnosis is made by clinical examination with rectal Case Presentation: MGV patient, 50 years old, touch, PSA increase and histopathological analysis of male, reports sudden onset haematuria 2 years prostate biopsy, being graded according to the Gleason ago, associated with dysuria and urinary retention score (GS), which assesses primary and secondary tumor episodes. He claims to be an alcoholic and a smoker patterns on a scale of 1-5. , for each respectively. In for 40 years and has no history in the cancer family. 2016, the International Society for Urological Pathology The patient was referred to a cancer referral hospital recommended a new classification where GS 9 and 10 where a CT scan was performed, which revealed a 6 cm scores represent aggressive tumors. When indicating vegetative lesion in the lateral bladder wall. The patient treatment or the doctor should point out that no underwent a transurethral resection (TUR), whose treatment offers advantages over the others. However, anatomopathological report showed two samples in patients with high-risk tumor and life expectancy over with invasion of the bladder musculature, conclusive 10 years, a radical prostatectomy becomes indicated as for small cell carcinoma. MRI of the abdomen and part of multimodal treatment. When performing the pelvis were requested, with results of a nodule in procedure together with other therapies on hold, if the anterior bladder wall of 5, 2cmx3,7x4,6cm with there is a reduction in PSA values. The present study extension to the anterior layer of the musculature aims to analyze the associated costs, length of stay and without involvement of the prostate, without lymph mortality and remission rates after prostatectomy and node invasion and absence of metastasis. In view of radical prostatovesiculectotomy procedures in prostate the results, the patient was instructed to perform a cancer oncology among the population of Pará, from radical cystectomy; however, he did not accept this 2008 to 2018.Epidemiological and descriptive analysis procedure and only performed partial cystectomy. of data available in 2019. Cost records, average length The anatomopathological report of the surgical of stay, number of hospitalizations and mortality rates specimen showed a neuroendocrine tumor with deep associated with prostate malignancies were analyzed. bladder musculature extension with T2bN0M0 staging. Data were organized in Microsoft Excel and compared Postoperatively, she had no clinical complaints and was to information on the same themes, considering the discharged from hospital. Discussion: Bladder cancer is Brazilian territory.Between 2007 and 2018, there one of the most common urinary tract neoplasms with were 221 deaths and 593 hospitalizations related to 1.63 / 100,000 male cases and 0.93 / 100,000 female malignant prostate cancer in the state of Pará. The cases in the Northern region. However, small cell average cost between 4725.28 reais shows the values bladder carcinoma is a poorly differentiated, aggressive related to expenses with internal procedures, of 3133 and very rare tumor of the bladder neuroendocrine , 81 in 2007 to 5278.28 in 2018. The reflex is a smaller epithelium, corresponding to a prevalence of less than number of post-procedure deaths than 0.62 deaths 1% of all bladder tumors. The etiology of the disease per thousand inhabitants. from 3.03 in 2011 to 1.72 is unknown, however. Natural history of smoking is in 2018, with a reduction of 2.1 in average days of found in 65 to 79% of cases. Its treatment becomes
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very challenging as it presents clinical and macroscopic grave, foi realizado cirurgia controle de danos e characteristics similar to other histological types such encaminhamento à UTI, para posterior reabordagem. as urothelial carcinoma, requiring much attention of O anatomopatológico do material colhido evidenciou the pathologist in the analysis of transurethral resection lesão linfoproliferativa compatível com Linfoma não (TUR). This pathology has high metastatic potential and Hodgkin e, à imuno-histoquímica, Linfoma de Células poor prognosis. . Final considerations:It is evidenced B de alto grau, compatível com linfoma de Burkitti. that the small cell carcinoma is an extremely aggressive Conclusão: O linfoma não Hodgkin primário na adrenal and rare neuroendocrine tumor that unfortunately has é uma entidade rara, correspondendo a menos de 1% no consensus for the treatment in the world literature, dos casos de LNH, que apresenta evolução rápida e de being important to report new cases of this pathology mau prognóstico, pois está associado a sintomas de and to associate with the literature review for the insuficiência adrenal. A apresentação como abdome accomplishment of the early diagnosis and decision on agudo hemorrágico é rara. Estratégias de diagnóstico the best treatment. precoce, bem como tratamento multimodal cirúrgico e quimioterápico podem impactar positivamente na Contato: Elane Frota Aragão sobrevida dos pacientes. [email protected] Contato: Maurílio de Cássio Golineli [email protected] TEMÁRIO: URO ONCOLOGIA CÓDIGO: 87733 TEMÁRIO: URO ONCOLOGIA Case Report: ACUTE HEMORRHAGIC CÓDIGO: 87599 ABDOMEN-CLINICAL PRESENTATION NON- HODGKIN‘S LYMPHOMA IN SUPRARENAL CÂNCER DE PÊNIS COM UMA EVOLUÇÃO INCOMUM - RELATO DE CASO Autores: Maurílio de Cássio Golineli / GOLINELI, M. de C. / UNIVERSIDADE FEDERAL DA GRANDE DOURADOS; Autores: Daniel de Paula Santana / Santana, D. P. Fernanda Dantas / DANTAS, F. / UNIVERSIDADE FEDERAL / Hospital Araújo Jorge ; Ricardo Restivo de Castro DA GRANDE DOURADOS; Ana Laura Reichert Centenaro Teixeira / Teixeira, R. R. C. / Hospital Araújo Jorge. / CENTENARO, A.L.R. / UNIVERSIDADE FEDERAL DA GRANDE DOURADOS. Paciente JGF, masculino, 27 anos, agricultor, natural e procedente de Anápolis/Go, sem comorbidades, não Linfomas são diferenciações neoplásicas de células tabagista e não etilista. Há 01 ano, com uma lesão em linfóides normais. O linfoma não Hodgkin (LNH) é pênis que evoluiu em um intervalo de 03 meses com a 11º neoplasia mais freqüente no Brasil e estima- ulceração e necrose associada a linfonodomegalia se que 10.180 novos casos diagnosticados em 2018. inguinal à esquerda. A biópsia incisional desta lesão Sua prevalência é maior na população com infecção realizada em serviço não especializado confirmou pelo HIV, cujo risco é 60-100 vezes superior. Quanto um carcinoma espinocelular ( CEC) moderadamente às manifestações, o acometimento extranodal é raro diferenciado. Ao exame físico: lesão ulcerada e (10% a 35% dos casos), e atinge o trato gastrintestinal necrótica extensa em glande mais linfonodomegalia em sua maioria. O linfoma primário de glândulas inguinal palpável à esquerda. TC de pelve evidenciando adrenais, devido a agressividade, a forma mais comum linfonodomegalia inguinal bilateral com realce pelo de apresentação é a insuficiência adrenal primária. contraste. Realizado penectomia parcial. Utilizado Paciente feminino, 28 anos, com diagnóstico prévio antibiótico por 14 dias. Anatomopatológico confirmou de Síndrome da Imunodeficiência Adquirida, em uso CEC, grau II, invasão até corpo esponjoso, margens irregular de TARV, internada por quadro de cefaléia livres, pT2. Sem regressão da linfonodomegalia após intensa em queimação, hemicraniana direita, com uso do antibiótico. Biópsia incisional do linfonodo irradiação occipital, associada à visão turva e acromática inguinal esquerdo confirmou CEC. Após 02 meses, foi à direita. Evoluiu com paralisia de hemiface esquerda, encaminhado para um serviço especializado já com seguida de ptose palpebral direita, hemiparesia e grande área de ulceração e necrose inguinal à esquerda hemiplegia em hemicorpo direito. Em tratamento para e exames de imagens mostrando evolução da doença neurotoxoplasmose. Durante internação apresentou inguinal. Submetido a resseção da tumoração inguinal quadro de hipotensão, dor abdominal e queda abrupta esquerda mais linfadenectomia inguino ilíaca com série vermelha no hemograma, sem apresentação clínica rotação de retalho (Drever). Ap confirmou metástase de sangramento externo. Investigação por exames de CEC para 04 linfonodos com doença extranodal. imagem tomografia computadorizada evidenciou Em um intervalo de 45 dias, paciente já evolui com imagem heterogênea perirrenal direita com extensão linfangite carcinomatosa bilateral, evidenciando uma infra-hepática, medindo 21,2 X 12 cm, borramento recidiva precoce da doença. Proposto esquema de da gordura perirrenal direita e conteúdo líquido na tratamento com quimioterapia mais radioterapia goteira parieto-cólica hematoma retroperitoneal? no intuito de evitar a ulceração da doença. Paciente Cisto hepático roto? A paciente foi submetida a evoluiu com importante sangramento inguinal devido a uma laparotomia exploradora, onde foi observado ulceração vascular tumoral, vindo a óbito. O câncer de hematoma retroperitoneal e grande quantidade de pênis é uma neoplasia maligna incomum que tem um sangue na cavidade abdominal. Depois de retirada do efeito devastador no paciente, além de ser um desafio coágulo e de material para biópsia, paciente apresentava para diagnosticar e tratar. Acomete preferencialmente sangramento difuso e quadro de choque hipovolêmico homens a partir da sexta década, com pico de incidência
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aos 80 anos. As lesões penianas primárias devem ser As metástases da parede abdominal subcutânea do abordadas inicialmente quando for cirurgicamente CCRs são incomuns e implicam um prognóstico ruim viável e clinicamente apropriado com técnicas cirúrgicas e sobrevida curta. Ocorrem como um evento tardio na que visem a preservação. Avanços na detecção e no progressão da doença e, portanto, apenas uma fração gerenciamento de linfonodos inguinais, melhorou o de pacientes pode sobreviver por tempo suficiente resultado clínico do câncer de pênis. Os diferentes para a detecção de massa metastática. A ressecção sistemas de estadiamento e a falta de padronização de cirúrgica por si só não parece afetar significativamente condutas clínicas contribuem para vieses na avaliação o curso clínico. A cura dificilmente é possível, servindo individual dos casos e resultam em dificuldades na apenas para melhorar a qualidade de vida desses abordagem terapêutica. Este caso, apresenta uma pacientes. Comentários finais: Embora o tumor de evolução incomum do câncer de pênis em um paciente células claras seja o principal tipo de CCRs, a presença jovem com recidiva muito precoce da doença. de metástase como implante de parede abdominal apresenta-se raramente. Assim, mostra-se importante Contato: Daniel de Paula Santana o relato de caso, visto que existem poucos dados acerca [email protected] do assunto na literatura internacional, inclusive em relação às decisões terapêuticas e suas implicações.
TEMÁRIO: URO ONCOLOGIA Contato: Icaro de Azevedo Alexandre CÓDIGO: 87341 [email protected]
IMPLANTE EM PAREDE ABDOMINAL DEVIDO A UMA NEOPLASIA DE CÉLULAS CLARAS: UM TEMÁRIO: URO ONCOLOGIA CÓDIGO: 88217 RELATO DE CASO Autores: ícaro de Azevedo Alexandre / Alexandre, I. A. / LAPAROSCOPICAL RADICAL CYSTECTOMY UFFS; Renata Bruna García dos Santos Gatelli / Gatelli, R. WITH BRICKER EXTRACORPOREAL RECON- B. G. S. / HCPF; Charles Nilton Gatelli / Gatelli, C. N. / HCPF; STRUCTION IN A BLADDER NEOPLASIA PATIENT Eduardo Scharnovski / Scharnovski, E. / UPF; Fernanda Pinho Tagliari / Tagliari, F. P. / UPF; Isabella Kern Arendt / Autores: Daniel Carvalho Ribeiro / RIBEIRO, D. C . / HOSPITAL Arendt, I. K. / UPF; Leonardo Werner Rasche / Rasche, L. DO CÂNCER DE MURIAÉ - FUNDAÇÃO CRISTIANO VARELLA; W. / UPF; Nathalia Rochinhas da Costa Portella / Portella, Thais Regina Valente de Sousa / SOUSA, T. R . / HOSPITAL N. R. C. / UPF; Letícia Signori Kohl / Kohl, L.S. / UFFS; DO CÂNCER DE MURIAÉ - FUNDAÇÃO CRISTIANO VARELLA; Mariana Gregório / Gregório, M. / UFFS. Abilio Castro Almeida / ALMEIDA, A.C . / HOSPITAL DO CÂNCER DE MURIAÉ - FUNDAÇÃO CRISTIANO VARELLA; Caso:Sexo feminino, 58 anos, natural e procedente Pedro Ribeiro Mota / MOTA, P. R . / HOSPITAL DO CÂNCER de Passo Fundo, em acompanhamento com o serviço DE MURIAÉ - FUNDAÇÃO CRISTIANO VARELLA; Rafael de oncologia clínica do Hospital da Cidade de Passo Miranda de Oliveira / OLIVEIRA, R. M . / HOSPITAL DO Fundo devido à nefrectomia radical esquerda por CÂNCER DE MURIAÉ - FUNDAÇÃO CRISTIANO VARELLA; carcinoma de células renais (T3 NX M0). Tomografia Bruno de Oliveira Pacheco / PACHECO, B. O . / HOSPITAL abdominal de controle evidenciou formações DO CÂNCER DE MURIAÉ - FUNDAÇÃO CRISTIANO VARELLA; nodulares peritoneais, retroperitoneais e na parede Jason Lucas Sales Junior / JUNIOR, J. L . / HOSPITAL abdominal do flanco esquerdo, com densidade de DO CÂNCER DE MURIAÉ - FUNDAÇÃO CRISTIANO partes moles e realce pelo meio de contraste, a VARELLA; Maria Fernanda Botelho Teixeira / TEIXEIRA, maior medindo 2,0x1,8 cm nos seus maiores eixos. M. F . / HOSPITAL DO CÂNCER DE MURIAÉ - FUNDAÇÃO Apresentava massa em parede abdominal, sem dor CRISTIANO VARELLA; Edson Augusto Prachia Ribeiro ou demais fatores acompanhantes. Realizado biópsia / RIBEIRO, E. A . / HOSPITAL DO CÂNCER DE MURIAÉ - excisional da lesão. Anatomopatológico evidenciou FUNDAÇÃO CRISTIANO VARELLA; Ithalo Henrique Alves neoplasia de células claras em segmento de partes Pereira / PEREIRA, I. H . / UNIFAMINAS - MURIAÉ. moles da parede abdominal, a qual media 3,5x3,5x2cm. Iniciado tratamento quimioterápico com interferon e Introduction: Bladder cancer is among the most após sunitinib. Discussão: Os carcinomas de células common, with high morbidity and mortality. The renais (CCR) compreendem 1% a 3% de todas as treatment of this pathology includes radical cystectomy, neoplasias malignas viscerais. Atualmente, a maioria which can be performed laparoscopically, with lower dos CCRs é descoberta incidentalmente em exames patient morbidity. Objective: To present the step by step de imagem realizados por razões urológicas ou não. of the surgical technique adopted in laparoscopic radical 33% dos pacientes já apresenta metástases à distância cystectomy with extracorporeal bricker reconstruction no momento do diagnóstico. O principal tipo é o de in a patient with bladder neoplasia. Methods: The células claras (60% dos casos). O quadro clínico inicial é procedure was performed in a male patient in 2019, composto de hematúria, dor lombar e massa em flanco diagnosed with muscle-invasive transitional cell palpável. O diagnóstico de CCR é sugerido por TC, carcinoma. Results: The surgical time was 250 minutes, realizada como medida inicial na avaliação de hematúria, with estimated bleeding of 250ml. The patient was uma lesão metastática enigmática ou achados discharged on the seventh postoperative day with laboratoriais suspeitos. O tumor frequentemente ureteral splits. The anatomopathological report showed produz metástase para os pulmões, linfonodos muscle invasive transitional cell carcinoma. The ureteral adjacentes no hilo renal e lesões líticas principalmente splits were removed 14 days after surgery. Conclusion: em ossos longos. Metástases de músculo esquelético Laparoscopic radical cystectomy with extracorporeal de carcinoma de células claras são raramente relatadas. bricker reconstruction is a safe, reproducible technique
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with superior results compared to the conventional TEMÁRIO: URO ONCOLOGIA approach. CÓDIGO: 88213
Contato: Thaís Regina Valente de Sousa RENAL CELL CARCINOMA IN THE CONTEXT [email protected] OF TUBEROUS SCLEROSIS: A CASE REPORT AND LITERATURE REVIEW TEMÁRIO: URO ONCOLOGIA Autores: Daniel Carvalho Ribeiro / RIBEIRO, D.C. CÓDIGO: 88366 / HOSPITAL DO CÂNCER DE MURIAÉ - FUNDAÇÃO CRISTIANO VARELLA; Thaís Regina Valente de Sousa MIELOLIPOMA SUPRA ADRENAL RELATO DE / SOUSA, T. R . / HOSPITAL DO CÂNCER DE MURIAÉ - CASO FUNDAÇÃO CRISTIANO VARELLA; Abílio Castro Almeida / ALMEIDA, A.C . / HOSPITAL DO CÂNCER DE MURIAÉ Autores: Jacira Patricia Rocha Monteiro / MONTEIRO, J. P. - FUNDAÇÃO CRISTIANO VARELLA; Pedro Ribeiro Mota R. / HU-UFAL; Caroline Carvalho Ferro / FERRO, C. C. / HU- / MOTA, P. R . / HOSPITAL DO CÂNCER DE MURIAÉ UFAL; Júlia Teresa de Albuquerque Celestino / CELESTINO, - FUNDAÇÃO CRISTIANO VARELLA; Rafael Miranda J. T. A. / HU-UFAL; Elizabete Gonçalves dos Santos / SANTOS, Oliveira / OLIVEIRA, R. M . / HOSPITAL DO CÂNCER E. G. / HU-UFAL; Cássia Priscilla Tenório Do Nascimento / DE MURIAÉ - FUNDAÇÃO CRISTIANO VARELLA; Bruno NASCIMENTO, C. P. T. / HU-UFAL; Rômulo Figueirêdo de de Oliveira Pacheco / PACHECO, B. O . / HOSPITAL Araújo / ARAÚJO, R. F. / HU-UFAL; Anna Karoline Rocha de DO CÂNCER DE MURIAÉ - FUNDAÇÃO CRISTIANO Sousa / SOUSA, A. K. R. / HU-UFAL; Theodorico Fernandes VARELLA; Maria Fernanda Botelho Teixeira / TEIXEIRA, da Costa Neto / NETO, T. F. C. / HU-UFAL; Tadeu Gusmão M. F . / HOSPITAL DO CÂNCER DE MURIAÉ - FUNDAÇÃO Muritiba / MURITIBA, T. G. M. / HU-UFAL; Adriana Melo CRISTIANO VARELLA; Edson Augusto Prachia Ribeiro Barbosa Costa / COSTA, A. M. B. / HU-UFAL. / RIBEIRO, E. A . / HOSPITAL DO CÂNCER DE MURIAÉ - FUNDAÇÃO CRISTIANO VARELLA; Jason Lucas Sales Introdução: O mielolipoma adrenal é um tumor Junior / JUNIOR, J. L . / HOSPITAL DO CÂNCER DE MURIAÉ mesenquimal raro, benigno, não funcional - FUNDAÇÃO CRISTIANO VARELLA; Ithalo Henrique hormonalmente, composto de tecido adiposo maduro Alves Pereira / PEREIRA, I. H . / UNIFAMINAS - MURIAÉ. e ilhotas de tecido mielóide. Caso: A.C, sexo masculino, 58 anos, com queixa de dor lombar à esquerda a 1 Abstract Tuberous sclerosis is caused by the mutated ano e meio, que piora aos esforços físicos. Realizou TSC1 genes hamartin, and the TSC2 gene tuberin. Patients ultrassonografia de abdome total que evidenciou uma with this complex develop typical skin symptoms such nodulação hipoecóica em topografia esplênica sem as angiofibromas of the skin as well as other lesions, fluxo ao doppler medindo 10x9.2x10.9cm. Á tomografia astrocytomas in the brain and lymphangioleiomyomatosis de abdome confirmou um extenso angiomiolipoma no in the lung. It is known that there is an increased incidence polo superior do rim esquerdo medindo 10.5x8.6cm, of renal cell carcinoma in connection with tuberous apresentando compressão sob a face medial do baço sclerosis. Objective: To report the case of a 36 years old e posterior do pâncreas, sem plano gordoroso de female patient diagnosed with Tuberous Sclerosis with separação com a artéria esplênica anterosuperiormente right kidney injury in the middle third. Having undergone e estabelecendo contato com a grande curvatura Videolaparoscopic Partial Nephrectomy. Histopathological gástrica relacionado a angiomiolipoma. Paciente foi examination showed a renal cell carcinoma degree 2 of submetido à adrenalectomia videolaparoscópica à Furhman. Methods: Literature Review in the context of esquerda e o tumor ressecado foi enviado para estudos Tuberous Sclerosis. Results: The literature review reveals patológicos, cujo o relatório descreveu como nódulo the rarity of the reported case and the importance of encapsulado amarelado, medindo 10.5x10.5x5cm, knowing this association between tuberous sclerosis revelando neoplasia mista caracterizada pela and renal cell carcinoma. Conclusion: Here we report proliferação de tecido adiposo típico e tecido mielóide a challenging case of a 36 years old female patient with representado por células de medula óssea incluindo tuberous sclerosis and skin angiofibromas and renal cell células eritróides, mielóides e megacarióticos de padrão carcinoma. habitual, fechando o diagnóstico de mielolipoma encapsulado. Discussão: A incidência de mielolipoma é Contato: Thaís Regina Valente de Sousa relatada como sendo de 0,08% a 0,4% como achado em [email protected] autópsias e a maioria dos casos é detectada também incidentalmente através de exames de imagem. Mas embora a TC e a RM possam sugerir um diagnóstico de TEMÁRIO: URO ONCOLOGIA mielolipoma, estas não são conclusivas. Mielolipomas CÓDIGO: 87766 pequenos (<4 cm de diâmetro) geralmente são assintomáticos, tornam-se sintomáticos à medida RISK FACTORS AND POST-PROSTATECTOMY que aumenta de tamanho, devido ao efeito de massa ou hemorragia que provoca. Considerações finais: PROGNOSIS: MULTIVARIABLE ANALYSIS Com menos de 50 casos relatados como sintomáticos OF 415 PATIENTS OPERATED IN A SINGLE e de patogênese desconhecida, constituindo assim INSTITUTION em um tumor raro e com indicação cirúrgica quando Autores: Luiza Mesquita Barbosa / Barbosa, L.M. / sintomático. Hospital Erasto Gaertner; Ewerson Luiz Cavalcanti Silva / Silva, E.L.C. / Hospital Erasto Gaertner; Julia Goginski / Contato: Jacira Patricia Rocha Monteiro Goginski, J. / Hospital Erasto Gaertner; Marcelo Tsuyoshi [email protected]
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Yamane / Yamane, M.T. / Hospital Erasto Gaertner; João / Maia, G.T.S / IMIP; Felipe da Silva Marinho / Marinho, Lucas Aleixes Sampaio Rocha / Rocha, J.L.A.S. / Hospital F.S / IMIP; Angelo Teles de Carvalho Filho / Filho, A.T.C Erasto Gaertner; Alisson Carvalho de Freitas / Freitas, / IMIP; Omar Jacobina de Figueiredo / Figueiredo, O.J / A.C. / Hospital Erasto Gaertner; Ronald Kool / Kool, R. / IMIP; Pedro José Galvão Freire / Freire, P.J.G / Hospital Hospital Erasto Gaertner; Raphaella Ferreira / Ferreira, das Clinicas - UFPE; Vandre Cabral Gomes Carneiro / R. / Hospital Erasto Gaertner; Phellipe Abreu / Abreu, Carneiro, V.C.G / IMIP. P. / Hospital Erasto Gaertner; Flavio Daniel Saavedra Tomasich / Tomasich, F.D.S. / Hospital Erasto Gaertner. Case Presentation: A 39-year-old man, previously healthy, with rectal intense pain, progressive intestinal Summary Objective: To analyze the surgical and constipation, one episode of hematochezia and weight oncological outcomes of radical prostatectomies, loss in one year. Digital rectal examination detected a establishing risk factors for the surgical procedure hard tumoral mass of posterior area of the prostate and and prognostic factors for overall survival. Methods: important narrowing of low rectum with intact mucosa. Retrospective descriptive comparative study. For patients Initial laboratory including prostate specific antigen (PSA) with prostate cancer submitted to radical prostatectomy and carcinoembryonic antigen (CEA) were normal. Were during the period from January 2009 to Dec-2015 at performed colonoscopy attesting extrinsic compression Hospital Erasto Gaertner de Curitiba-PR. Statistical of low rectal part and integrity of mucosa. Computed analyses were performed by the SPSS 23.0 and STATA Tomography (CT) and MRI evidenced a nine centimeters 15 programs, and p<0.05 were considered statistically (in larger diameter) solid cystic tumor in seminal vesicles significant. Results: The group presented median age area compressing the bladder posteriorly and the low of 65 years with a majority in good general condition, rectum anteriorly. Transrectal core biopsy analysis with Performance Status 0 in 205 (54.7%) cases. Family immunohistochemistry suggested a epithelial neoplasm history of cancer was reported in 63 (24.5%) cases. Rectal with clear cells focus with PSA, Chromogranin, P63, examination of the prostate was normal in 144 (34.7%) 34BE12, Synaptophysin negative, CEA inconclusive and patients. Mean value of PSA in the initial evaluation was cytokeratin (CK7), AE1AE3 positive and CA125 positive in 9.2 ng/ml, and after surgical treatment was 0.22 ng/ some cells. Thorax CT and superior abdominal CT ruled ml. After surgery, 170 (48.6%) patients had PSA lower out signs of malignancy. The presenting findings were than 0.2 ng/ml. The initial Gleason classification was consistent with primary seminal vesicle carcinoma (SVC). equal to or lower than 6 in 260 (62.7%) patients, and Facing an imminent bowel obstruction and progressive in 155 (37.3%) patients it was higher than 6. The same voiding symptoms was performed an enbloc total pelvic evaluation performed after treatment showed 141 (34%) exenteration, pelvic lymphadenectomy and double- and 274 (66%), respectively. Tumors were confined to the barrelled wet colostomy reconstruction. Histopathological prostate in 268 (64.6%) cases. The seminal vesicle was examination of the specimen showed a papillary and solid infiltrated by a tumor in 52 (12.7%) cases. The operative carcinoma in seminal vesicle area compromising bladder, procedure was performed by the Open Approach in the prostate and rectum (serous membrane). No lymph node great majority of cases 384 (92.5%), only 31 (7.5%) by the involvement were find. Withing two months postoperative Laparoscopic Approach. The overall survival in 5 years patient presented symptoms of bowel obstruction due to was 95.4%. Univariate analysis showed that risk factors adhesion (surgical biopsy with no signs of neoplasm) with for worse prognosis were tumors with extracapsular fully recovery after surgical intervention. Not proposed any invasion, compromised surgical margins, invasion of adjuvant treatment. In ten months postoperative follow- seminal vesicles, positive lymph nodes and Gleason up patient presented with no symptoms and no image above 6. In multivariate analysis, only extracapsular sign of disease recurrence. Discussion: Primary malignant invasion and Gleason above 6 were significant. As for tumors of seminal vesicle are a very rare entity. It is most long-term complications (1 year) after the procedure, secondarily involved from adjacent organs, mainly the we found 40 (9.9%) of Urinary Incontinence, 69 (17.6%) prostate. Adenocarcinoma is the most common primary of Erectile Dysfunction and 4 (1%) of Urethral Stenosis. subtype. Seminal vesicle mass as primary involvement Conclusions: Extra capsular invasion and degree of could be ressectable although there is no standard tumor differentiation above Gleason 6 represent the treatment protocol available and also no long term survival main factors influencing post-prostatectomy survival. data. Final comments: Seminal vesicle carcinoma are a rare neoplasm and should differentially diagnosed from Contato: Luiza Mesquita Barbosa secondary involvement. Surgical approach appears to be [email protected] the best option for localized disease until now
Contato: Thais da Costa Pinto Rodrigues TEMÁRIO: URO ONCOLOGIA [email protected] CÓDIGO: 87912
SURGICAL APPROACH OF PRIMARY SEMINAL TEMÁRIO: URO ONCOLOGIA VESICLE CARCINOMA (SVC): A RARE CASE CÓDIGO: 88160 REPORT TOTAL PANCREATECTOMY FOR RECURRENCE Autores: Thais da Costa Pinto Rodrigues / Rodrigues, OF RENAL CELL CARCINOMA: CASE REPORT T.C.P / IMIP; Antonio Cavalcanti de Albuquerque AND LITERATURE REVIEW Martins / Martins, A.C.A / IMIP; Cristiano de Souza Leão / Leão, C.S / IMIP; Françualdo Ribeiro de Sá Barreto / Autores: Guillermo Manozzo Trevisol / Trevisol, G. M. / Barreto, F.R.S / IMIP; Guilherme Tavares da Silva Maia Ac Camargo Cancer Center; Igor Correia de Farias / De
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Farias, I. C. / Ac Camargo Cancer Center; André Luís de TEMÁRIO: URO ONCOLOGIA Godoy / De Godoy, A. L. / Ac Camargo Cancer Center; CÓDIGO: 87192 Héber Salvador de Castro Ribeiro / Ribeiro, H. S. / Ac Camargo Cancer Center; Wilson Luiz da Costa Júnior / UMBILICAL METASTASIS IN UROTHELIAL Júnior, W. L. / Ac Camargo Cancer Center; Alessandro CANCER - CASE REPORT Landskron Diniz / Diniz, A. L. / Ac Camargo Cancer Center; Felipe José Fernandez Coimbra / Coimbra, F. J. / Autores: Marcelo Zeni / Zeni, M. / Universidade Federal Ac Camargo Cancer Center; Sílvio Melo Torres / Torres, da Fronteira Sul; Lia Regina de Sampaio / Sampaio, L. S. M. / Ac Camargo Cancer Center; Cícero Diego Soares R. / Universidade Federal da Fronteira Sul; Matheus dos Santos / Dos Santos, C. D. / Ac Camargo Cancer Pelinski da Silveira / Da Silveira, M. P. / Universidade Center; Andrey Richard Lisboa Martins / Martins, A. R. / Federal da Fronteira Sul; Deoclécio Luchini Júnior / Ac Camargo Cancer Center. Luchini Júnior, D. / Universidade Federal da Fronteira Sul; Rogger Elano Hoeltgebaum Rodrigues / Rodrigues, Case Report: A 53-year-old male smoker and ex- R. E. H. / Universidade Federal da Fronteira Sul. alcohoolist patient, ASA III, ECOG 0, history of upper esophageal squamous cell carcinoma treated with Case Report: A 74-year-old male patient was referred four cycles of Cisplatin, 5-FU with 3D conformal to the Uro-Oncology outpatient clinic of a hospital in the radiotherapy (50.4Gy) until October 2012, present a interior of Santa Catarina state for follow-up of bladder right renal nodule on CT follow up in September 2013. neoplasia with hypogastric pain and macroscopic The patient underwent right radical nephrectomy in hematuria. On physical examination, he presented November 2013 and the histologic diagnosis was clear a herniated violaceous umbilical lesion, painful to cell renal carcinoma, histologic grade 3, nuclear grade 2, palpation. He underwent transurethral resection 3.0 cm and negative margins (pT1aN0M0). The patient of the bladder prior to neoadjuvant chemotherapy remained oncologic follow-up until June 2015, when a and subsequently to Bricker urinary diversion with pulmonary nodule present on CT, and right lower lobe umbilical biopsy, confirming metastasis of high-grade segmentectomy was indicated, with pathological result urothelial carcinoma. Discussion: Bladder cancer of Clear Cell Renal Carcinoma metastasis pulmonary is the ninth most common cancer in the world and parenchyma with free margins. Again, he maintained most commonly occurs in males (3: 1), with a median cancer follow-up until March 2017 when a suspicious age at diagnosis of 73 years. Among the histological image appeared in the left ischium. This image was types, urothelial carcinoma represents about 90% of confirmed via percutaneous biopsy (clear cell renal all cases. The main risk factor for the development carcinoma metastasis) and treated with radiotherapy of urothelial carcinoma is smoking, present in 50- in April 2017. During the same period, a fine needle 80% of cases. Its main sites of metastasis are lymph aspiration thyroid nodule was suspected for malignancy, nodes, lungs and bones. Umbilical metastasis from and a partial thyroidectomy was performed, confirming the abdominal or pelvic organ is known as Sister metastasis of renal cell carcinoma. At the same Mary Joseph nodule (SMJN) and it may appear as period, there was an imaging diagnosis of pancreatic the first sign of an abdominal neoplasm as well as disease progression and, due to the scenario at the already diagnosed neoplasia metastasis. Clinically, it is time, systemic treatment with Pazopanib 800mg was occasionally irregular, may or may not be painful, has indicated. He was treated with 20 Pazopanib cycles or has not ulcerative features with escape of different from June 2017 until February 2019 when pancreatic content, variable size being common between 0.5 disease progressed again. Pazopanib was replaced and 2 cm. It is generally more related to gastric by Nivolumab and the patient did 5 Nivolumab cycles and pancreatic tumors, with few case descriptions from February 2019 to May 2019 and, again, pancreatic of urothelial tumors. The presence of this sign is disease progressed. At this time, the patient evolved to related to a poor prognosis, with a low survival rate cholangitis and was admitted to hospital via emergency to its onset. The case presents a SMJN from advanced room in May 2019 requiring ERCP and biliary stenting. urothelial cancer, which on complementary exams PET-CT showed disease activity exclusively at the showed signs of regional infiltration without distant pancreatic site. Case discussed at a multidisciplinary metastases. Patient had an unresectable disease and meeting and total pancreatectomy was indicated due was submitted to a palliative procedure to preserve a to progression-free interval at other sites and exclusive minimum quality of life. Final comments: The SMJN disease at pancreatic site, now symptomatic due to biliary is a sign of metastasis of abdominal neoplasms, obstruction. Patient underwent total pancreatectomy rarely seen or perceived in current practice, but when and splenectomy in July 2019. Discussion and Final present has important prognostic value. It is usually comments: Pancreatic metastasis corresponds to a related to gastric and gynecological tumors and may minority of tumors affecting the organ, and in the case be present in other cancers, as in the present report, of renal cell carcinoma, surgical treatment is based on where it was related to advanced urothelial neoplasia, the literature. with a poor prognosis.
Contato: Guillermo Manozzo Trevisol Contato: Matheus Pelinski da Silveira [email protected] [email protected]
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