- Email: [email protected]
P87 Breast cancer presenting as gastric signet ring cell carcinoma
Abstracts
1 European
Journal
of Internal
colon and breast, WITH 5FU AND TAMOXIFEN TREATMENT AND NO recurrence. The studies performed revealed a severe hipocromic anemia (Hb=5.5 g/dL) and a platelet count of 909.OOO/mL. The upper GI endoscopy demonstrated an erosive gastritis and non-ulcerated duodenal polyps. Histology of the duodenal mucosa showed infiltration with CD 19 +, 20+ lymphocytes, IN A LYMPHOEPITHELIAL PATTERN, that, on flow citometry analisys, exibithed kappa light-chain restriction (DUODENAL MALT-LYMPHOMA). There was no involvment of other organs or the bone marrow with lymphoma cells. The Marrow biopsy showed dysmorphic maturation of megacariocytes suggestive of Essential Thrombocythemia. The patient was treated with Rituximab and Hidroxiurea with excelent tolerance. The haemoglobin levels rose to 10 g/dL and the platelet counts are still above 1,5OO,OOO/mL. An elevated platelet count is common in NHL (16% of cases), which is unusual is that this thrombocytosis be due to an intrinsically defective maturation of platelets, with FEW cases reported. The hability of the lymphoma cells to modulate maturative processes in the bone marrow is well known, but the existence of a maturative defect, common to both cell lineages, cannot be excluded. The co-existence of these two rare diagnoses raises the question of whether we are in the presence of a fortuitous association or of a novel disease entity with an as yet non-defined pathogenesis (RESULTING FROM PRIOR CHEMOTHERAPY?).
P84 Uterine Myoma is an ectopic souse of erythropoietin production I. Maslovsky, 0. Gemer, I. Shcherbina, D. Gefel (Ashkelon, IL) A syndrome characterized by elevated total body red cell mass called polycythemia. Polycythemic states include polycythemia vera (a primary marrow disorder) and large group secondary polycythemias divided in two pathogenically different types. Polycythemia, which characterized by erythron, normally responding to hypoxic states, recognized as appropriate secondary polycythemia; and a condition when erythron responds to aberrant production of erythropoietin comprises another type of secondary polycythemia, called inappropriate. All types of secondary polycythemia characterized by high level of erythropoietin contrary to polycythemia Vera. Erythropoietin secreted largely by kidney tissue. A small additional amount of erythropoietin is secreted by liver cells. It is not surprisingly, that ectopic erythropoietin production and consequently inappropriate secondary polycythemia occur in renal and liver malignancies. Other tumors only rarely comprise a cause of polycythemia. We describe a severely polycythemic young woman that suffered from huge uterine myoma. Secondary nature of her polycythemia was confirmed by high erythropoietin concentration in her plasma and complete disappeatante of polycythemia after tumor resection. A far higher concentration of erythropoetin was found in tumor cystic fluid confirming uterine souse of erythropoietin secretion.
P85 Association between alopecia and response to chemotherapy patients with Hodgkin’s lymphoma A. Elis, D. Blickstein, Y. Manor, M. Lishner (1) (Kfar Saba, Tel-Aviv,
in IL)
Purpose: To validate our clinical observation that the lack of alopecia in Hodgkin’s lymphoma patients, treated with chemotherapy, may predict for a poor response to treatment together with a low rate of bone marrow suppression. Patients and methods; A cohort study was conducted in 66 patients with Hodgkin’s lymphoma that were treated between 1991 and 2001 with at least 4 courses of doxorubicin containing chemotherapy (MOPP/ABV or ABVD) in 2 university affiliated hematology departments. Thirty-four patients sustained complete or near complete alopecia and 32 retained
Medicine
14 (2003)
S57
SI -S159
their hair or had only minimal hair loss. The 2 groups were compared by response to treatment and episodes of bone marrow suppression. Resulrs: More patients with alopecia achieved complete remission (79% vs. 31%, P
P86 Enoxaparin emholi D. Zamir,
induced
thrombocytopenia
I. Polychuck,
I. Leibovitz,
complicated T. Reitblat
with
(Ashkelon,
pulmonary IL)
Low molecular weight heparins especially are widely used in the last decade especially for prophylaxis of deep vein thrombophlebitis. Enoxaparin induced thrombocytopenia is a rare accurrance, in contrary to the high prevalence (2-5%) of this complication in patients treated with unfractionated heparin. We report here a case of a patient who developed pulmonary emboli secondary to proximal deep vein thrombophlebitis 2 weeks after having undergone prostatectomy, although he was treated prophylactically with low dose enoxaparin. His normal platelets count (255 X 109/L) decreased to 30X 109/L. Antibody testing against heparin was positive. Enoxaparin was replaced for a coumarin derivative (warfarin) and an inferior vena caval filter was inserted. Within a few days platelet count increased to lOO,OOO/iL. Pulmonary symptoms improved and he was released in a good clinical condition. Heparin induced thrombocytopenia (HIT) is discussed here as well as the alternative treatments for unfractionated heparins and low-molecular-weight heparins.
P87 Breast cancer presenting as gastric signet ring ceil carcinoma F.A.R.M. Warmerdam. B. de Valk, J.L.C. Blaauwgeers. K.J. Roozendaal (Amsterdam, NL) Background; Gastric metastases resembling linitis plastica is a rare but previously described event in the course of breast cancer. We describe a patient initially presenting with a linitis plastica and multiple metastatic bone lesions while further examination of her mastopathic breast revealed an occult, small primary breast tumour; a situation to our best knowledge not reported in literature before. Case: A 73-year-old woman with a 5 months history of epigasttic discomfort and satiety after minor food intake presented with anaemia. Biopsies taken from a gastric lesion resembling linitis plastica showed a signet ring cell type adenocarcinoma. On CAT scan performed prior to an intentionally curative gastric resection, multiple osteolytic lesions throughout the spinal cord were seen. Bone marrow biopsy showed massive infiltration by signet ring shaped carcinoma cells. Given the moderate symptoms of the disease palliative surgery was not indicated. A couple of weeks later at the outward patients clinic on physical examination, firm-to-hard breast masses were palpable and described as mastopathy. Additional immunohistochemical staining of the gastric biopsies for oestrogen and progesterone receptors nonetheless showed to be strongly positive. A mammography was done but no suspect lesions could be detected. Acknowledging possible malignancies of the breast staying clinically occult when mastopathy is present stimulated us to further
S.58
Abstracts
I European
Journal
of Internal
examination. On MRI scan of the mammae finally a small suspected lesion in the right breast was seen. True cut biopsy of the breast lesion revealed a hormone receptors-positive ductal adenocarcinoma with focal differentiation to signet ring cells. Immunohistochemical comparison of the 3 tumours strongly suggested the malignancy originating from the breast. Treatment with Tamoxifen was started.
PS8 Intravenous I. Maslovsky
iron in outpatient (Ashkelon, IL)
settings
Parenteral iron preparations needed for patients who iron deficiency cannot be treated with oral iron. It is clearly consent that oral treatment with iron is preferable for general population and in use for majority of cases. Parenteral iron indicated for patients with unacceptable gastrointestinal side effects induced by oral iron per se, patients suffering from inflammatory bowel disease, which exacerbates by oral iron, patients with inefficient intestinal absorption, patients with renal insufficiency treated with erythropoietin and patients with unresolved ongoing chronic bleeding overwhelming acceptable oral doses of iron preparations. Serious side effects of iron dextran in the past influenced the less than needed use of this effective treatment. A total of 34 iron deficient patients were treated with intravenous iron on an ambulatory basis. The iron gluconate was administered in dose 62.5 mg iron diluted in 150 ml normal saline given intravenously over 30 min, while iron sucrose was given in dose 100 mg iron diluted in the same volume and given over 30 min. There were a total of 341 infusions administered, 96 of iron gluconate and 245 of iron sucrose. The frequency of infusions depended of underlying disease and ranged from twice a week to maintenance once a month. The adverse effects were rare and minor in patients receiving iron gluconate, and were not occur in patients treated with iron sucrose. There were two cases of flushing with paresthesias terminated simply with lowering of infusion rate and one mild hypotension treated successfully with 500 cc normal saline infusions. One patient stopped treatment, because fear of more serious side effects, the two remaining continued treatment protocol. There were no serious side effects, anaphylactic reactions or nausea. The new iron parenteral preparations, either iron gluconate or iron sucrose, are effective, safe and may be used by family physicians in properly equipped clinics. The risk of side effects of new iron intravenous preparation is low comparative to iron dextran historical control.
P89 Non-tropical idiopathic splenomegaly case A. Lopez de la Osa, J.M. Femandez Sanchez Martin, J.J. Lopez Cidfuentes
(Dacie’s
syndrome):
Pelaez, C. Sanchez (Ciudud Real, E)
report Tapia,
of a E.
Non-tropical idiopathic splenomegaly (Dacie’s syndrome) is a form of hypersplenism of unknown origin that evolves into a non-Hodgkin lymphoma, after a variable interval, in 20% of the 46 cases described in the literature. We report the case of 36-year-old man that debuted with unknown origin fever and massive splenomegaly twenty years ago for which no cause was determined. He was admitted with abdominal pain and features of hypersplenism. Several studies do not seem to be related with known pathogenetic mechanisms (functional workload, malignant infiltration and inflammatory or storage disorders). Finally a splenectomy and liver biopsy was performed and histological features of the spleen were non-specific and included congestive changes, fibrosys and chronic inflammation with a marked decreasing of lymphoid tissue. A year post-splenectomy the patient has no symptoms. Nontropical idiopathic splenomegaly, or Dacie’s syndrome is rare. This disease should be keep in mind as dianostic differential of hypersplenism of unexplained origin.
Medicine
14 (2003)
Sl -S159
P90 The diagnostic value of EBV detection using PCR carcinoma to cervical lymph nodes A.M. Rizk, S.M. Hamam, SM. Abd El-Salam (Alexandria,
in metastatic EG)
In nasopharyngeal carcinoma, the primary lesion is difficult to find. Metastasis occurs frequently to neck nodes and is difficult to distinguish form other head and neck tumours. As EBV has been implicated in the etiology of NPC, the aim of the present work was to identify the viral genome of the EBV in the cells of this carcinoma in an attempts to differentiate it form other metastatic head and neck tumours. The conducted study comprised 40 cases of metastatic tumours to neck nodes, twenty of which were NPC and twenty were other head and neck carcinomas. Twenty more cases were controls. It was found that all cases of nasopharyngeal carcinoma were EBV positive and monoclonal, while the other metastatic head and neck carcinomas showed positive EBV in only 60% of cases, and these cases were all polyclonal. Also 45% of the control cases were EBV positive and also polyclonal. It may thus be concluded form the present study that PCR, through amplification of the EBV genome, is a reliable technique in differentiating NPC metastatic to neck nodes form other metastatic head and neck tumours.
P91 Primary maligant melanoma of the esophagus L. Correia, M.J.N. Silva, S. Santo, P. Cartes, C. Crujo, Fernandes, J. Freire, F. Santos, A. Esteves (&boa, P)
M. Smit,
A.
Primary malignant melanoma of the esophagus is both a rare presentation for melanoma and a cause of esophageal neoplasm. It accounts for less than 0.1% of all primary esophageal neoplasms with only about 220 cases reported to date. The tumour is highly malignant and has a poor prognosis, with an average survival of 12 months and a five year survival of 4.2%. At present, the treatment of choice is surgical ressection. Neither chemotherapy nor radiotherapy have affected mortality appreciably. Imunotherapy with (Y interferon has been reported as improving prognosis, but has not been fully evaluated. We describe a 79 year-old womam who presented, in May 2002, with a 5 month history of progressive disphagia for solid foods, without weight loss or other syntomatology. Upper endoscopy revealed a polypoid mass suggesting esophageal neoplasm. Biopsies yielded a histologic diagnosis of malignant melanoma. The endoscopic ultrassonography confirmed a solid, low ecodensity mass with 3.5 X2.2 cm, narrowing middle l/3 esophagus lumen. Thoracic and abdominal CT showed no evidence of metastatic disease. Since the clinical and radiographic evaluation excluded alternative primary source, the diagnosis of primary malignant esophageal melanoma was made. The patient underwent subtotal esophagectomy via transthoracic approach and cervical esophagogastric anastomosis. Histology and imunohistochemistry confirmed malignant melanoma with surgical margins free of tumour, but with rare images of vascular invasion of submucosal veins. Adjuvant therapy with OL interferon was started and fifteen months after the onset of symptoms the patient was doing well without evidence of recurrence. Conclusion: The authors describe a case of primary malignant esophageal melanoma with 15 months of evolution that showed an uncommun favorable response to surgery and imunotherapy.
P92 Neuroendocrine Tumour of Syndrome E. Eiras, J. Moreira, M. Mota, The authors
present
the
pancreas
J. Valente
a case of a young
with
(Porte,
female,
Ectopic
Cushing’s
P)
age 22, Caucasian,
with
no
1 European
Journal
of Internal
colon and breast, WITH 5FU AND TAMOXIFEN TREATMENT AND NO recurrence. The studies performed revealed a severe hipocromic anemia (Hb=5.5 g/dL) and a platelet count of 909.OOO/mL. The upper GI endoscopy demonstrated an erosive gastritis and non-ulcerated duodenal polyps. Histology of the duodenal mucosa showed infiltration with CD 19 +, 20+ lymphocytes, IN A LYMPHOEPITHELIAL PATTERN, that, on flow citometry analisys, exibithed kappa light-chain restriction (DUODENAL MALT-LYMPHOMA). There was no involvment of other organs or the bone marrow with lymphoma cells. The Marrow biopsy showed dysmorphic maturation of megacariocytes suggestive of Essential Thrombocythemia. The patient was treated with Rituximab and Hidroxiurea with excelent tolerance. The haemoglobin levels rose to 10 g/dL and the platelet counts are still above 1,5OO,OOO/mL. An elevated platelet count is common in NHL (16% of cases), which is unusual is that this thrombocytosis be due to an intrinsically defective maturation of platelets, with FEW cases reported. The hability of the lymphoma cells to modulate maturative processes in the bone marrow is well known, but the existence of a maturative defect, common to both cell lineages, cannot be excluded. The co-existence of these two rare diagnoses raises the question of whether we are in the presence of a fortuitous association or of a novel disease entity with an as yet non-defined pathogenesis (RESULTING FROM PRIOR CHEMOTHERAPY?).
P84 Uterine Myoma is an ectopic souse of erythropoietin production I. Maslovsky, 0. Gemer, I. Shcherbina, D. Gefel (Ashkelon, IL) A syndrome characterized by elevated total body red cell mass called polycythemia. Polycythemic states include polycythemia vera (a primary marrow disorder) and large group secondary polycythemias divided in two pathogenically different types. Polycythemia, which characterized by erythron, normally responding to hypoxic states, recognized as appropriate secondary polycythemia; and a condition when erythron responds to aberrant production of erythropoietin comprises another type of secondary polycythemia, called inappropriate. All types of secondary polycythemia characterized by high level of erythropoietin contrary to polycythemia Vera. Erythropoietin secreted largely by kidney tissue. A small additional amount of erythropoietin is secreted by liver cells. It is not surprisingly, that ectopic erythropoietin production and consequently inappropriate secondary polycythemia occur in renal and liver malignancies. Other tumors only rarely comprise a cause of polycythemia. We describe a severely polycythemic young woman that suffered from huge uterine myoma. Secondary nature of her polycythemia was confirmed by high erythropoietin concentration in her plasma and complete disappeatante of polycythemia after tumor resection. A far higher concentration of erythropoetin was found in tumor cystic fluid confirming uterine souse of erythropoietin secretion.
P85 Association between alopecia and response to chemotherapy patients with Hodgkin’s lymphoma A. Elis, D. Blickstein, Y. Manor, M. Lishner (1) (Kfar Saba, Tel-Aviv,
in IL)
Purpose: To validate our clinical observation that the lack of alopecia in Hodgkin’s lymphoma patients, treated with chemotherapy, may predict for a poor response to treatment together with a low rate of bone marrow suppression. Patients and methods; A cohort study was conducted in 66 patients with Hodgkin’s lymphoma that were treated between 1991 and 2001 with at least 4 courses of doxorubicin containing chemotherapy (MOPP/ABV or ABVD) in 2 university affiliated hematology departments. Thirty-four patients sustained complete or near complete alopecia and 32 retained
Medicine
14 (2003)
S57
SI -S159
their hair or had only minimal hair loss. The 2 groups were compared by response to treatment and episodes of bone marrow suppression. Resulrs: More patients with alopecia achieved complete remission (79% vs. 31%, P
P86 Enoxaparin emholi D. Zamir,
induced
thrombocytopenia
I. Polychuck,
I. Leibovitz,
complicated T. Reitblat
with
(Ashkelon,
pulmonary IL)
Low molecular weight heparins especially are widely used in the last decade especially for prophylaxis of deep vein thrombophlebitis. Enoxaparin induced thrombocytopenia is a rare accurrance, in contrary to the high prevalence (2-5%) of this complication in patients treated with unfractionated heparin. We report here a case of a patient who developed pulmonary emboli secondary to proximal deep vein thrombophlebitis 2 weeks after having undergone prostatectomy, although he was treated prophylactically with low dose enoxaparin. His normal platelets count (255 X 109/L) decreased to 30X 109/L. Antibody testing against heparin was positive. Enoxaparin was replaced for a coumarin derivative (warfarin) and an inferior vena caval filter was inserted. Within a few days platelet count increased to lOO,OOO/iL. Pulmonary symptoms improved and he was released in a good clinical condition. Heparin induced thrombocytopenia (HIT) is discussed here as well as the alternative treatments for unfractionated heparins and low-molecular-weight heparins.
P87 Breast cancer presenting as gastric signet ring ceil carcinoma F.A.R.M. Warmerdam. B. de Valk, J.L.C. Blaauwgeers. K.J. Roozendaal (Amsterdam, NL) Background; Gastric metastases resembling linitis plastica is a rare but previously described event in the course of breast cancer. We describe a patient initially presenting with a linitis plastica and multiple metastatic bone lesions while further examination of her mastopathic breast revealed an occult, small primary breast tumour; a situation to our best knowledge not reported in literature before. Case: A 73-year-old woman with a 5 months history of epigasttic discomfort and satiety after minor food intake presented with anaemia. Biopsies taken from a gastric lesion resembling linitis plastica showed a signet ring cell type adenocarcinoma. On CAT scan performed prior to an intentionally curative gastric resection, multiple osteolytic lesions throughout the spinal cord were seen. Bone marrow biopsy showed massive infiltration by signet ring shaped carcinoma cells. Given the moderate symptoms of the disease palliative surgery was not indicated. A couple of weeks later at the outward patients clinic on physical examination, firm-to-hard breast masses were palpable and described as mastopathy. Additional immunohistochemical staining of the gastric biopsies for oestrogen and progesterone receptors nonetheless showed to be strongly positive. A mammography was done but no suspect lesions could be detected. Acknowledging possible malignancies of the breast staying clinically occult when mastopathy is present stimulated us to further
S.58
Abstracts
I European
Journal
of Internal
examination. On MRI scan of the mammae finally a small suspected lesion in the right breast was seen. True cut biopsy of the breast lesion revealed a hormone receptors-positive ductal adenocarcinoma with focal differentiation to signet ring cells. Immunohistochemical comparison of the 3 tumours strongly suggested the malignancy originating from the breast. Treatment with Tamoxifen was started.
PS8 Intravenous I. Maslovsky
iron in outpatient (Ashkelon, IL)
settings
Parenteral iron preparations needed for patients who iron deficiency cannot be treated with oral iron. It is clearly consent that oral treatment with iron is preferable for general population and in use for majority of cases. Parenteral iron indicated for patients with unacceptable gastrointestinal side effects induced by oral iron per se, patients suffering from inflammatory bowel disease, which exacerbates by oral iron, patients with inefficient intestinal absorption, patients with renal insufficiency treated with erythropoietin and patients with unresolved ongoing chronic bleeding overwhelming acceptable oral doses of iron preparations. Serious side effects of iron dextran in the past influenced the less than needed use of this effective treatment. A total of 34 iron deficient patients were treated with intravenous iron on an ambulatory basis. The iron gluconate was administered in dose 62.5 mg iron diluted in 150 ml normal saline given intravenously over 30 min, while iron sucrose was given in dose 100 mg iron diluted in the same volume and given over 30 min. There were a total of 341 infusions administered, 96 of iron gluconate and 245 of iron sucrose. The frequency of infusions depended of underlying disease and ranged from twice a week to maintenance once a month. The adverse effects were rare and minor in patients receiving iron gluconate, and were not occur in patients treated with iron sucrose. There were two cases of flushing with paresthesias terminated simply with lowering of infusion rate and one mild hypotension treated successfully with 500 cc normal saline infusions. One patient stopped treatment, because fear of more serious side effects, the two remaining continued treatment protocol. There were no serious side effects, anaphylactic reactions or nausea. The new iron parenteral preparations, either iron gluconate or iron sucrose, are effective, safe and may be used by family physicians in properly equipped clinics. The risk of side effects of new iron intravenous preparation is low comparative to iron dextran historical control.
P89 Non-tropical idiopathic splenomegaly case A. Lopez de la Osa, J.M. Femandez Sanchez Martin, J.J. Lopez Cidfuentes
(Dacie’s
syndrome):
Pelaez, C. Sanchez (Ciudud Real, E)
report Tapia,
of a E.
Non-tropical idiopathic splenomegaly (Dacie’s syndrome) is a form of hypersplenism of unknown origin that evolves into a non-Hodgkin lymphoma, after a variable interval, in 20% of the 46 cases described in the literature. We report the case of 36-year-old man that debuted with unknown origin fever and massive splenomegaly twenty years ago for which no cause was determined. He was admitted with abdominal pain and features of hypersplenism. Several studies do not seem to be related with known pathogenetic mechanisms (functional workload, malignant infiltration and inflammatory or storage disorders). Finally a splenectomy and liver biopsy was performed and histological features of the spleen were non-specific and included congestive changes, fibrosys and chronic inflammation with a marked decreasing of lymphoid tissue. A year post-splenectomy the patient has no symptoms. Nontropical idiopathic splenomegaly, or Dacie’s syndrome is rare. This disease should be keep in mind as dianostic differential of hypersplenism of unexplained origin.
Medicine
14 (2003)
Sl -S159
P90 The diagnostic value of EBV detection using PCR carcinoma to cervical lymph nodes A.M. Rizk, S.M. Hamam, SM. Abd El-Salam (Alexandria,
in metastatic EG)
In nasopharyngeal carcinoma, the primary lesion is difficult to find. Metastasis occurs frequently to neck nodes and is difficult to distinguish form other head and neck tumours. As EBV has been implicated in the etiology of NPC, the aim of the present work was to identify the viral genome of the EBV in the cells of this carcinoma in an attempts to differentiate it form other metastatic head and neck tumours. The conducted study comprised 40 cases of metastatic tumours to neck nodes, twenty of which were NPC and twenty were other head and neck carcinomas. Twenty more cases were controls. It was found that all cases of nasopharyngeal carcinoma were EBV positive and monoclonal, while the other metastatic head and neck carcinomas showed positive EBV in only 60% of cases, and these cases were all polyclonal. Also 45% of the control cases were EBV positive and also polyclonal. It may thus be concluded form the present study that PCR, through amplification of the EBV genome, is a reliable technique in differentiating NPC metastatic to neck nodes form other metastatic head and neck tumours.
P91 Primary maligant melanoma of the esophagus L. Correia, M.J.N. Silva, S. Santo, P. Cartes, C. Crujo, Fernandes, J. Freire, F. Santos, A. Esteves (&boa, P)
M. Smit,
A.
Primary malignant melanoma of the esophagus is both a rare presentation for melanoma and a cause of esophageal neoplasm. It accounts for less than 0.1% of all primary esophageal neoplasms with only about 220 cases reported to date. The tumour is highly malignant and has a poor prognosis, with an average survival of 12 months and a five year survival of 4.2%. At present, the treatment of choice is surgical ressection. Neither chemotherapy nor radiotherapy have affected mortality appreciably. Imunotherapy with (Y interferon has been reported as improving prognosis, but has not been fully evaluated. We describe a 79 year-old womam who presented, in May 2002, with a 5 month history of progressive disphagia for solid foods, without weight loss or other syntomatology. Upper endoscopy revealed a polypoid mass suggesting esophageal neoplasm. Biopsies yielded a histologic diagnosis of malignant melanoma. The endoscopic ultrassonography confirmed a solid, low ecodensity mass with 3.5 X2.2 cm, narrowing middle l/3 esophagus lumen. Thoracic and abdominal CT showed no evidence of metastatic disease. Since the clinical and radiographic evaluation excluded alternative primary source, the diagnosis of primary malignant esophageal melanoma was made. The patient underwent subtotal esophagectomy via transthoracic approach and cervical esophagogastric anastomosis. Histology and imunohistochemistry confirmed malignant melanoma with surgical margins free of tumour, but with rare images of vascular invasion of submucosal veins. Adjuvant therapy with OL interferon was started and fifteen months after the onset of symptoms the patient was doing well without evidence of recurrence. Conclusion: The authors describe a case of primary malignant esophageal melanoma with 15 months of evolution that showed an uncommun favorable response to surgery and imunotherapy.
P92 Neuroendocrine Tumour of Syndrome E. Eiras, J. Moreira, M. Mota, The authors
present
the
pancreas
J. Valente
a case of a young
with
(Porte,
female,
Ectopic
Cushing’s
P)
age 22, Caucasian,
with
no