Adenocarcinoma gástrico do tipo difusode células em anel de sinete: relato de caso / Signet ring diffus cell gastric adenocarcinoma: case report

O câncer gástrico é um dos tumores malignos mais comuns. A classificação histológica de Lauren o diferencia em dois subtipos, intestinal e difuso, este sendo um tipo indiferenciado, com pior prognóstico. Foi realizado um relato de caso, utilizando história e exames colhidos através de prontuário médico de um hospital de João Pessoa – PB, e pesquisa na base de dados Scielo. D.S.C, 60 anos, deu entrada no serviço de Cirurgia Oncológica do Hospital de referência em câncer da região, com queixa de disfagia para sólidos e líquidos há 40 dias e perda de peso nesse ínterim. Foi realizada endoscopia digestiva alta que evidenciou estômago com volume e distensibilidade diminuídos. Corpo distal e pequena curvatura apresentando lesão ulcerada, com fibrina recobrindo-a e limites não definidos devido à estenose desse segmento, impossibilitando a passagem de sonda nasoentérica. Enquanto aguardava laudo histopatológico optou-se pela realização de jejunostomia para suporte enteral. Na cirurgia, observou-se volumoso tumor de estômago, sendo realizada gastrojejunostomia pré-cólica e ileotransversoanastomose, à jusante da obstrução. O paciente evoluiu bem clinicamente, recebendo alta hospitalar e sendo encaminhado para avaliação de quimioterapia. O Laudo histopatológico evidenciou a presença de um adenocarcinoma pouco diferenciado do tipo difuso de células em anel de sinete. O diagnóstico precoce é um grande desafio devido a sintomatologia inespecífica ou ausente nas fases iniciais da doença, que prejudica uma terapêutica curativa e evidencia como uma alternativa pertinente a abordagem paliativa. 

AVANÇOS RECENTES NO DIAGNÓSTICO PRECOCE DO CÂNCER DE PULMÃO: UMA ANÁLISE DE REVISÕES SISTEMÁTICAS

The high mortality rate from lung cancer, the leading cause of cancer death in Brazil, highlights the urgent need for effective screening and early diagnosis policies. Late detection, often in advanced stages, compromises treatment options. The aim of this study was to reflect on the importance of recent advances in the early diagnosis of lung cancer. A systematic literature review was carried out using the Scielo, Lilacs and Medline databases. After a qualitative analysis of the results, it was concluded that early identification of the disease allows for more effective therapeutic interventions, resulting in greater survival and better clinical outcomes for patients.A alta taxa de mortalidade pelo câncer de pulmão, principal causa de óbito por câncer no Brasil, ressalta a urgência de políticas efetivas de rastreamento e diagnóstico precoce. A detecção tardia, frequentemente nos estágios avançados, compromete as opções de tratamento. Este estudo teve como objetivo refletir sobre a importância do avanços recentes no diagnóstico precoce do câncer de pulmão. Para isso, foi desenvolvida uma revisão sistemática da literatura, utilizando as bases de dados Scielo, Lilacs e Medline. Após análise qualitativa dos resultados, concluiu-se que a identificação precoce da doença permite intervenções terapêuticas mais eficazes, resultando em maior sobrevida e melhores resultados clínicos para os pacientes

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030