Browsing by Author "Caldeira Fradique, A"
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- Adenocarcinoma do Íleon. Uma Entidade Rara e de Diagnóstico TardioPublication . Nabais, C; Salústio, R; Bispo, C; Sousa, F; Porto, E; Cardoso, C; Silva, G; Caldeira Fradique, AINTRODUÇÃO A neoplasia do intestino delgado é uma entidade rara, apresentando uma incidência anual de cerca de 2.1 casos por 100,000 pessoas, sendo o adenocarcinoma, o segundo tipo histológico mais frequente (em 33% dos casos). A localização distal deste tipo de tumor é menos habitual, o que torna o adenocarcinoma do íleon num evento invulgar. A raridade deste tipo de patologia, associada a uma apresentação clínica pouco específica, origina habitualmente um atraso no diagnóstico e tratamento. CASO CLÍNICO Doente de 66 anos admitida no S.U. com quadro de dor abdominal localizada na fossa ilíaca direita com cerca de 6 dias de evolução e agravamento progressivo. Anorexia, náuseas e vómitos no dia de admissão. Empastamento doloroso à palpação na fossa ilíaca direita. Exames complementares revelaram tumor inflamatório do apêndice ileocecal. Intraoperatoriamente constatou-se neoformação com envolvimento do apêndice ileocecal, cego e segmento de íleon distal. Adenopatias na raíz do mesentério. Optou-se pela realização de hemicolectomia direita com ressecção em bloco de íleon distal. O resultado histológico revelou adenocarcinoma do íleon, que se estendia ao apêndice ileocecal e condicionando apendicite aguda (pT4N0). DISCUSSÃO/CONCLUSÃO Este caso apresenta uma patologia pouco frequente, caracterizada por um diagnóstico tardio e de difícil realização. Sublinhamos neste trabalho, a importância de um diagnóstico mais precoce e um tratamento adequado, de forma a obter um aumento da taxa de sobrevivência destes doentes.
- Adenocarcinoma of the Ileum: A Rare and Challenging EntityPublication . Nabais, C; Salústio, R; Sousa, F; Porto, E; Cardoso, C; Caldeira Fradique, AINTRODUCTION: Primary small bowel malignancy is unusual and accounts for 1-3% of all gastrointestinal tract neoplasms. Adenocarcinoma is one of the most common histologic types, but its frequency decreases with more distal locations. Its clinical presentation is nonspecific and is usually associated with advanced disease, which contributes to delayed diagnosis. PRESENTATION OF CASE: A 66-year-old woman was admitted to the hospital with a 6-day history of progressively worsening abdominal pain localized in the right lower quadrant, nausea, and vomiting. Investigation revealed an inflammatory appendiceal tumor. The patient underwent surgery and an unexpected tumor involving the distal ileal segment and ileocecal appendix was found. Right radical hemicolectomy with en bloc resection of the distal ileum was performed. Histopathological examination revealed adenocarcinoma of the ileum. DISCUSSION: This rare entity is associated with a nonspecific clinical presentation that contributes to delayed diagnosis and treatment, and consequently to a worse prognosis. Approximately half of the cases are only diagnosed at surgery. Primary treatment consists of wide resection with locoregional lymphadenectomy. The role of adjuvant chemotherapy has yet to be determined. CONCLUSION: This case demonstrates an unusual condition characterized by late and challenging diagnosis. We highlight the importance of an earlier diagnosis and optimal treatment for improved patient outcomes.
- Esophageal Cancer: Results of the Trimodal Approach in a Medium-Volume Multidisciplinary UnitPublication . Carrola Gomes, D; Caldeira Fradique, A; Costa, L; Quaresma, L; Gualdino Silva, J; Vasconcelos, V; Sacadura, J; Oliveira, M; Esteves, J; Mateus Marques, R; Fernandez, G; Guedes da Silva
- Gastric MANECs: a Casuistic of a Portuguese CentrePublication . Aguiar, C; Caldeira Fradique, A; Quaresma, L; Matias, R; Gualdino Silva, J; Vasconcelos, V; Sacadura, J; Oliveira, M; Cabrita, F; Mateus Marques, R; Esteves, J; Costa, L; Fernandez, G; Guedes da Silva
- Ki-67 Proliferation Index in Gastric Cancer - Biologic SignificancePublication . Nabais, C; Caldeira Fradique, A; Oliveira, M; Quaresma, L; Gualdino Silva, J; Vasconcelos, V; Sacadura, J; Costa, L; Cabrita, F; Mateus Marques, R; Esteves, J; Fernandez, G; Guedes da SilvaObjectives/Introdution: Ki-67 protein has been used as an indicator of proliferation activity in tumor cells. In gastric cancer the prognostic value has not been fully understood. This study was designed to assess the biologic significance of Ki-67 proliferation index (PI) in gastric cancer. Material/Methods: Seventy-two patients with gastric cancer were evaluated. These patients underwent gastric resection, and the tumor tissue was stained immunohistochemically. Ki-67 PI was defined as the percentage of tumor cells positive for Ki-67. Ki-67 PI was correlated with clinicopathological characteristics and patient survival. Results: A low Ki-67 PI (less than or equal to 50%) was associated with poorly differentiated histology - diffuse type (p=0.009) and signet ring cells (p=0.004) - and younger age (p=0.022). A worse prognosis in patients with low Ki-67 PI was also found (a mean survival of 41.8 vs 63 months for high Ki-67 PI group), but not statistically significant (p=0.623, log rank test). Discussion/Conclusion: We found an inversely correlation between Ki-67 PI and histological differentiation grade. Patients in group with low Ki-67 PI are younger, with poorly differentiated histology and have a lower mean survival. Like other studies already suggested, we may have two different tumors phenotypes - highly invasive with low proliferative capability, and less invasive potential with higher proliferative ability. However, in this sample, no significant prognostic value was achieved between both.
- Neuroendocrine Carcinoma of the Esophagus: Single-Center Experience of 5 CasesPublication . Corado, S; Caldeira Fradique, A; Figueiredo, J; Quaresma, L; Pupo, A; Sacadura, J; Vasconcelos, V; Gualdino Silva, J; Fernandez, G; Costa, L; Mateus Marques, R; Oliveira, M; Esteves, J; Guedes da Silva; Barroso, E
- Sentinel Lymph Node in Gastric CancerPublication . Quaresma, L; Caldeira Fradique, A; Oliveira, M; Gualdino Silva, J; Vasconcelos, V; Sacadura, J; Mateus Marques, R; Esteves, J; Costa, L; Fernandez, G; Guedes da Silva
- Synchronous Gastric Tumours: Two Different CasesPublication . Vicente, C; Santos, JA; Sacadura, J; Quaresma, L; Guedes da Silva, J; Caldeira Fradique, A; Silva, G; Oliveira, M; Costa, L; Esteves, J; Mateus Marques, R