Person: Schiappacasse, Giancarlo
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Schiappacasse
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Giancarlo
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Publication Caracterización del perfil epidemiológico, patológico, radiológico y de manejo de los pacientes con tumores estromales del tubo digestivo. Experiencia chilena de cinco años(2024) Schiappacasse, Giancarlo; Cocio, Rolando; Cristi, J.; Torres, Javiera; Aliaga, Francisca; Vial, Macarena; Hepp, Juan; Castiblanco, AdrianaIntroducción y objetivos Los tumores del estroma gastrointestinal (GIST) son las neoplasias mesenquimáticas más frecuentes del tubo digestivo y su expresión y manejo dependen de su agresividad. Nuestro objetivo es caracterizar los GIST diagnosticados en nuestro centro, a partir de variables epidemiológicas, anatomopatológicas, imagenológicas y de manejo. Material y métodos Estudio observacional de cohorte retrospectiva en pacientes adultos con diagnóstico de GIST mediante imágenes y biopsia entre los años 2017 y 2022 en nuestro centro, caracterizando datos epidemiológicos, imagenológicos, de anatomía patológica y terapéuticos. Resultados Se incluyeron 33 pacientes, promedio de edad 59 años. La mayoría fue un hallazgo incidental (54.5%) y de los sintomáticos, lo más frecuente fue hemorragia digestiva (24%). La ubicación más frecuente fue el estómago (19/33 casos) y su forma de presentación exofítica fue la más habitual (48.5%). Imagenológicamente, su impregnación fue mayormente heterogénea y progresiva y 54% presentaron alguna característica intrínseca, siendo la necrosis/áreas quísticas lo más frecuente, sin casos de invasión local ni diseminación a distancia. Histológicamente la variante fusada fue la más frecuente (78.8%) y la mayoría presentaron menos de cinco mitosis por campo mayor. En nuestro recinto, 30 casos fueron tratados, siendo la cirugía la forma de resolución más frecuente (29/30). No se registraron muertos a causa de GIST en nuestra serie. Conclusiones Nuestra serie tiene características epidemiológicas e imagenológicas similares a la literatura, diferenciándose por un diagnóstico precoz y baja agresividad de los casos. Introduction and aims Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal neoplastic tumors of the gastrointestinal tract and their expression and management is dependent on their aggressivity. Our aim was to characterize the GISTs diagnosed at our center, analyzing the epidemiologic, anatomopathologic, imaging study, and management variables. Material and methods A retrospective, observational cohort study was conducted on adult patients diagnosed with GIST through imaging studies and biopsy, within the time frame of 2017 and 2022 at our center, characterizing the epidemiologic, imaging study, anatomopathologic, and therapeutic data. Results Thirty-three patients with a mean age of 59 years were included. The majority of cases were incidental findings (54.5%), and of the symptomatic cases, the most frequent presentation was gastrointestinal bleeding (24%). The most common location was the stomach (19/33 cases), and the most frequent presentation was exophytic (48.5%). In the imaging studies, impregnation was mainly heterogeneous and progressive and 54% had an intrinsic characteristic, with necrosis/cystic areas the most frequent feature. There were no cases of local invasion or distant metastasis. Histologically, the spindle cell type was the most frequent (78.8%) and the majority had fewer than 5 mitoses per high power field. Thirty cases were treated at our center and surgery was the most frequent form of resolution (29/30). No deaths caused by GIST were registered in our case series. Conclusions The epidemiologic and imaging study characteristics in our case series were similar to those reported in the literature, but our results were different, with respect to early diagnosis and the low aggressivity of the cases.Publication Austral Journal of Imaging(2024) Schiappacasse, Giancarlo; Gómez, Manuel; Cocio, Rolando; Molina, Nicolás; Sáez, FelipeAnatomical variants in the cervical spine musculature and shoulder girdle are relatively uncommon and have the potential to cause functional and postural abnormalities, which in turn could cause chronic pain and a sensation of mass. The case of a 66-year-old woman is presented, in whom a computed tomography scan shows the anomalous insertion of an accessory belly of the levator scapulae muscle, which is inserted into the serratus anterior muscle fascia and second rib, causing cervicalgia and palpable asymmetry in the soft tissues of the neck. It is important to report these anatomical variants to explain certain physical disorders and clinical symptoms of the cervico-scapular region, guiding the treatment, the vast majority of which have kinesiological management. Las variantes anatómicas en la musculatura de la columna vertebral cervical y cintura escapular son relativamente infrecuentes y tienen el potencial de causar anomalías funcionales y posturales, que a su vez podrían provocar dolor crónico y sensación de masa. Se presenta el caso de una mujer de 66 años, en la que por medio de tomografía computarizada se evidencia la inserción anómala de un vientre accesorio del músculo elevador de la escápula, que se inserta en la fascia del músculo serrato anterior y segunda costilla, determinando cervicalgia y asimetría palpable en las partes blandas del cuello. Es importante reportar estas variantes anatómicas con el fin de explicar ciertos trastornos físicos y cuadros clínicos de la región cérvico-escapular, orientando el tratamiento, que en su gran mayoría tienen manejo kinesiológico.Publication Secondary rectal linitis plastica caused by prostatic adenocarcinoma - magnetic resonance imaging findings and dissemination pathways: A case report(2024) Labra, Andres; Schiappacasse, Giancarlo; Cocio, Rolando; Torres, Jorge; González, Fernando; Cristi, Joaquin; Schultz, MarcelaBackground: Secondary rectal linitis plastica (RLP) from prostatic adenocarcinoma is a rare and poorly understood form of metastatic spread, characterized by a desmoplastic response and concentric rectal wall infiltration with mucosal preservation. This complicates endoscopic diagnosis and can mimic gastrointestinal malignancies. This case series underscores the critical role of magnetic resonance imaging (MRI) in identifying the distinct imaging features of RLP and highlights the importance of considering this condition in the differential diagnosis of patients with a history of prostate cancer. Case summary: Three patients with secondary RLP due to prostatic adenocarcinoma presented with varied clinical features. The first patient, a 76-year-old man with advanced prostate cancer, had rectal pain and incontinence. MRI showed diffuse prostatic invasion and significant rectal wall thickening with a characteristic "target sign" pattern. The second, a 57-year-old asymptomatic man with elevated prostate-specific antigen levels and a history of prostate cancer exhibited rectoprostatic angle involvement and rectal wall thickening on MRI, with positron emission tomography/computed tomography PSMA confirming the prostatic origin of the metastatic spread. The third patient, an 80-year-old post-radical prostatectomy, presented with refractory constipation. MRI revealed a neoplastic mass infiltrating the rectal wall. In all cases, MRI consistently showed stratified thickening, concentric signal changes, restricted diffusion, and contrast enhancement, which were essential for diagnosing secondary RLP. Biopsies confirmed the prostatic origin of the neoplastic involvement in the rectum. Conclusion: Recognizing MRI findings of secondary RLP is essential for accurate diagnosis and management in prostate cancer patients.