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INTRODUCCIÓN: Los pólipos colónicos de acuerdo a su número, tamaño, localización, edad de presentación y sobre todo, de acuerdo a su estirpe histológica, tienen la potencialidad de degeneración maligna, lo que los hace susceptibles de un continuo estudio y seguimiento. OBJETIVOS: Evaluar la relación entre el tipo histológico de los pólipos de colon, su localización, el grado de displasia, el tamaño, su eventual compromiso por carcinoma, la edad, el sexo y el manejo que se les ha dado, en una serie de 684 pacientes del Instituto Nacional de Enfermedades Neoplásicas (INEN) entre el 1 de enero de 1974 al 31 de marzo del 2004. MATERIAL Y MÉTODOS: Se realizó la revisión de historias clínicas de 840 pacientes con el diagnóstico de pólipo de colon que asistieron al servicio de Gastroenterología del INEN entre el 1 de enero de 1974 al 31 de marzo de 2004 y se llenó una ficha prediseñada para cada historia clínica. El estudio es de tipo observacional, analítico y de corte transversal. Se evaluaron en este periodo 1162 pólipos resecados. No se incluyeron 156 pacientes por diagnóstico relacionado con cáncer y poliposis adenomatosa familiar. La muestra final fue de 684 pacientes, en los que se encontró 1057 pólipos. Otros hallazgos endoscópicos fueron: hemorroides internas (172), diverticulosis colónica (50), fisura anal (4), y colitis ulcerativa no específica (2). El procesamiento estadístico se realizó con el programa SPSS 12. Para las variables cualitativas se empleó el método del Chi-cuadrado, para las variables cuantitativas se analizaron la media, el rango y la varianza. RESULTADOS: Se extirparon 1057 pólipos, mediante la polipectomía endoscópica fueron 1016, con uso de colectomía fueron 32 y con resección transanal sin colectomía fueron 09. Dentro de la histología de los 1057 pólipos, se consignaron 331 (31.3%) que fueron hiperplásicos, 448 (42.4%) adenomas, 278 (26.3%) otros y 35 (8.2%) adenocarcinomas sobre adenomas. La edad media fue de 50 años, no hubo diferencia significativa con respecto al sexo. La localización mas frecuente de los adenomas fue en el colon izquierdo (76.6%). El adenocarcinoma (carcinomas sobre adenomas), estuvo presente principalmente en pólipos tipo velloso, con displasia severa y mayores a 10mm. Sin embargo, en pólipos menores de 5mm con displasia severa, se encontró un pólipo invadido por cáncer, que representa el 0.8% de pólipos milimétricos. El manejo realizado fue principalmente endoscópico, con el 96% de los pólipos resecados de esta manera, también se consigna resección transanal y resección colónica segmentaría. La colectomía fue necesaria solo en el 3% de todas las intervenciones realizadas, se realizó en pólipos adenomatosos con displasia severa o carcinoma, y en mayor porcentaje en pólipos mayores de 20mm (53%). La polipectomía sola fue suficiente en el nivel de invasión Haggitt 0. En pacientes con nivel de invasión Haggitt 1 y 2, la polipectomía sola fue el tratamiento de elección. Por otro lado, en pólipos con nivel de invasión Haggitt 3 y 4, la colectomía fue el tratamiento de elección. Se consignó dos complicaciones, una de perforación y peritonitis y otra de hemorragia digestiva baja (ambas: 0.29%), sin eventos de mortalidad. CONCLUSIONES: El manejo del pólipo de colon en el INEN es predominantemente endoscópico. Los pólipos son más frecuentes por encima de los 50 años y tienen localización preferente en el colon izquierdo. El carcinoma es más probable a mayor displasia y mayor tamaño del adenoma. Todo pólipo, desde los milimétricos, incluyendo los hiperplásicos, debe ser considerado marcador de proceso neoplásico y extirpado en su totalidad. INTRODUCTION: The colonics polyps according to their number, size, location, age of presentation and mainly, according to their histology, have the potentiality of malignant degeneration, which makes of a continuous study and pursuit susceptible. OBJECTIVES: To evaluate the relation between the histologic type of the colon polyps, its location, the degree of dysplasia, the size, its possible commitment by carcinoma, the age, sex and the handling that has occurred them, in a series of 684 patients of the National Institute of Enfermedades Neoplásicas (INEN) between the 1 of January from 1974 to the 31 of March of the 2004. MATERIAL AND METHODS: The revision of clinical histories of 840 patients with the diagnosis of colon polyp was made who attended the service of Gastroenterology of the INEN between the 1 of January from 1974 to the 31 of March of 2004 and a card predesigned for each clinical history filled. The study is of observational, analytical type and of cross section. 1162 resecteds polyps evaluated themselves in this period. 156 patients by diagnosis related to cancer and familiar adenomatouspoliposis did not include themselves. The final sample was of 684 patients, in whom it was 1057 polyps. Other endoscopic findings were: internal hemorrhoids (172), colonic diverticulosis (50), anal fissure (4), and nonspecific ulcerative colitis (2). The statistical processing was made with program SPSS 12. For the qualitative variables the method of the Chi-square was used, for the quantitative variables analyzed the average, the rank and the variance. RESULTS: 1057 polyps extirpated, by means of the endoscopy polipectomy were 1016, with colectomy were 32 and with transanal resection without colectomy they 9. Within the histology of the 1057 polyps, 331 was briefed (31.3%) that were hyperplasic, 448 (42.4%) adenomas, 278 (26.3%) others and 35 (8.2%) adenocarcinomas on adenomas. The average age was of 50 years, was no significant difference with sex. The location but frequents of the adenomas was in the left colon (76.6%). Adenocarcinoma (carcinomas on adenomas), was present mainly in polyps villous type, with dysplasia severe and greater to 10mm. Nevertheless, in smaller polyps of 5mm with dysplasia severe, was a polyp invaded by cancer, that represents the 0,8% of millimetric polyps. The made handling was mainly endoscopic, with 96% of the resected polyps this way, also slogan transanal resection and segmental colonic resection. The colectomy was necessary in 3% of all the made interventions, dysplasia severe or carcinoma was made in adenomatous polyps with, and in greater percentage in greater polyps of 20mm (53%). The single polipectomy was sufficient in the level of invasion Haggitt 0. In patients with level of invasion Haggitt 1 and 2, the single polipectomy was the election treatment. On the other hand, in polyps with level of invasion Haggitt 3 and 4, the colectomy was the election treatment. One briefed two complications, one of perforation and peritonitis and another one of digestive hemorrhage loss (both: 0.29%), without mortality events. CONCLUSIONS: The Evaluation of colonic polyps in INEN is predominantly by endoscopy. The polyps are more frequent over the 50 years and have preferred location in the left colon. The carcinoma is more probable with severe dysplasia and greater size of the adenoma. All polyps, from the millimetric ones, including the hyperplasic, must be considered marks of neoplasia and extirpated in its totality.

The colonics polyps according to their number, size, location, age of presentation and mainly, according to their histology, have the potentiality of malignant degeneration, which makes of a continuous study and pursuit susceptible.To evaluate the relation between the histologic type of the colon polyps, its location, the degree of dysplasia, the size, its possible commitment by carcinoma, the age, sex and the handling that has occurred them, in a series of 684 patients of the National Institute of Enfermedades Neoplásicas (INEN) between the 1 of January from 1974 to the 31 of March of the 2004.The revision of clinical histories of 840 patients with the diagnosis of colon polyp was made who attended the service of Gastroenterology of the INEN between the 1 of January from 1974 to the 31 of March of 2004 and a card predesigned for each clinical history filled. The study is of observational, analytical type and of cross section. 1162 resecteds polyps evaluated themselves in this period. 156 patients by diagnosis related to cancer and familiar adenomatouspoliposis did not include themselves. The final sample was of 684 patients, in whom it was 1057 polyps. Other endoscopic findings were: internal hemorrhoids (172), colonic diverticulosis (50), anal fissure (4), and nonspecific ulcerative colitis (2). The statistical processing was made with program SPSS 12. For the qualitative variables the method of the Chi-square was used, for the quantitative variables analyzed the average, the rank and the variance.1057 polyps extirpated, by means of the endoscopy polipectomy were 1016, with colectomy were 32 and with transanal resection without colectomy they 9. Within the histology of the 1057 polyps, 331 was briefed (31.3%) that were hyperplasic, 448 (42.4%) adenomas, 278 (26.3%) others and 35 (8.2%) adenocarcinomas on adenomas. The average age was of 50 years, was no significant difference with sex. The location but frequence of the adenomas was in the left colon (76.6%). Adenocarcinoma (carcinomas on adenomas), was present mainly in polyps villous type, with dysplasia severe and greater to 10 mm. Nevertheless, in smaller polyps of 5mm with dysplasia severe, was a polyp invaded by cancer, that represents the 0,8% of millimetric polyps. The made handling was mainly endoscopic, with 96% of the resected polyps this way, also slogan transanal resection and segmental colonic resection. The colectomy was necessary in 3% of all the made interventions, dysplasia severe or carcinoma was made in adenomatous polyps with, and in greater percentage in greater polyps of 20 mm (53%). The single polipectomy was sufficient in the level of invasion Haggitt 0. In patients with level of invasion Haggitt 1 and 2, the single polipectomy was the election treatment. On the other hand, in polyps with level of invasion Haggitt 3 and 4, the colectomy was the election treatment. One briefed two complications, one of perforation and peritonitis and another one of digestive hemorrhage loss (both: 0.29%), without mortality events.The Evaluation of colonic polyps in INEN is predominantly by endoscopy. The polyps are more frequent over the 50 years and have preferred location in the left colon. The carcinoma is more probable with severe dysplasia and greater size of the adenoma. All polyps, from the millimetric ones, including the hyperplasic, must be considered marks of neoplasia and extirpated in its totality.

Primary Gastric Lymphoma is an uncommon malignancy among gastric malignancies. Histology of the Primary Gastric Lymphoma is varied and the extranodal marginal zone B-cells lymphoma is specially significant on account of its potential remission with antibiotic therapy.Observe the clinical characteristics of patients with Primary Gastric Lymphoma, assess the most relevant endoscopic findings, identify the factors that influence survival and evaluate the effects of therapy.The study is an observational, analytical, cross evaluation including 169 patients with histological diagnosis of Gastric Lymphoma, treated at the National Institute for Neoplastic Diseases, Lima, Peru, from January 1995 to December 2000. Staging was based on the Ann Arbor system, modified by Musshoff and histology, on the REAL-WHO classification. The statistical analysis included the student-t and the chi-square tests. Survival data were entered using the Kaplan Meier curves and prognosis factors, using the Cox regression test.The sample represents patients from the Peruvian Coast, with a mean age of 55 years old and slight predominance of female patients (54.4%). Signs and symptoms are unspecific. Clinical stage I-II corresponds to 75% of the patients. The endoscopic pattern of multiple ulcerated lesions is characteristic of the Gastric Lymphoma. A total of 71% of the patients with extranodal marginal zone B-cells lymphoma showed total remission of the disease with antibiotic therapy (5/7). The histological type of the Gastric Lymphoma in the 169 patients was as follows: Large, diffuse, B-cells Lymphoma, 137 patients, extranodal marginal zone B-cells lymphoma, 16 patients, peripheral T-cell Lymphoma, 6 patients, anaplastic large T-cell Lymphoma, 3 patients, undetermined Lymphoma, 3 patients, mantle cell Lymphoma, 2 patients, adult T-cell Lymphoma, 1 patient and follicular Lymphoma, 1 patient. Global survival after 36 months was of 61.34%, survival according to the histological type was of 92.31% for extranodal marginal zone B-cells Lymphomas, 62.21% for large, diffuse B-cells Lymphomas and 29.63% for T-cell Lymphomas. Survival after 36 months in patients in clinical stage I-II treated with chemotherapy, was of 82.16%, with surgery, 71.89% and with surgery and chemotherapy, 70.39, with similar results in all three groups (p: 0.6530). The groups classified according to the international index, showed a clear difference between them (p:0.0000). The univariate analysis revealed that Zubrod (p:0.0000) DHL (p:0.0073) disease remission (p:0.0000) stage (p:0.0000) treatment (p:0.0000) and location (p:0.0000) had statistical significance. Multivariate analysis showed that in the Cox regression model, remission (OR:13,342, p:0.0000) and location (OR:2.375, p:0.041) fall within the equation of such function.The multiple ulcerated lesions are characteristic of the Gastric Lymphoma. Remission of the disease in the extranodal marginal zone B-cells Lymphoma is evidenced with the use of antibiotic therapy (5/7). Chemotherapy in patients with EC I-II achieves survival results similar to those treated with surgery and with a combination of both. Validity of the international index is confirmed and the multivariate analysis proved that remission and location of the disease have statistical significance.

Introducción: El Linfoma Gástrico Primario es una entidad infrecuente dentro de las neoplasias que afectan el estómago. La histología del Linfoma Gástrico Primario es variada y adquiere connotación especial el Linfoma a células B de la zona marginal extranodal, por su potencial remisión con la antibioticoterapia. Objetivos: Apreciar las características clínicas de los pacientes con Linfoma Gástrico Primario, los hallazgos endoscópicos más relevantes, identificar los factores que influencian la supervivencia y evaluar los efectos de la terapia. Material y métodos: El presente estudio es de tipo observacional, analítico y de corte transversal, se realizó en 169 pacientes con diagnóstico histológico de Linfoma Gástrico que fueron atendidos en el Instituto Especializado de Enfermedades Neoplásicas, Lima-Perú, desde Enero de 1995 a Diciembre del 2000. Para el estadiaje se utilizó el sistema Ann Arbor modificado por Musshoff y la histología de acuerdo a la clasificación REAL-WHO. El análisis estadístico incluyó el t de student y el chi cuadrado. La supervivencia fue consignada con las curvas de Kaplan Meier y los factores pronóstico con el test de regresión de Cox. Resultados: La muestra es representativa de pacientes de la Costa Peruana. La edad promedio es 55 años, con discreta predominancia del sexo femenino (54.4%). Los signos y síntomas son inespecíficos. El estadio clínico I-II corresponde al 75% de los pacientes. El patrón endoscópico de lesiones ulceradas múltiples es característico del Linfoma Gástrico. El 71% de los pacientes con Linfoma a células B de la zona marginal extranodal tuvieron remisión completa de la enfermedad con antibióticoterapia (5/7). El tipo histológico del Linfoma Gástrico en los 169 pacientes fue el siguiente: Linfoma a células B grande difuso 137 pacientes, Linfoma a células B de la zona marginal extra nodal 16 pacientes, Linfoma a células T periférico 6 pacientes, Linfoma a células grandes T anaplásico 3 pacientes, Linfoma no determinado 3 pacientes, Linfoma a células del manto 2 pacientes, Linfoma a células T del adulto 1 paciente y Linfoma folicular 1 paciente. La sobrevida global a 36 meses fue de 61.34%, la supervivencia de acuerdo al tipo histológico fue del 92.31% para Los Linfomas a células B de la zona marginal extranodal, del 62.21% para los Linfomas a células B grande difuso y del 29.63% para los Linfomas a células T. La sobrevida a 36 meses en pacientes con estadio clínico I-II que fueron tratados con quimioterapia fue del 82.16%, con cirugía fue del 71.89% y con cirugía más quimioterapia fue del 70.39%, mostrando los 3 grupos resultados semejantes (p: 0.6530). Los grupos catalogados de acuerdo al índice internacional, mostraron una clara diferencia entre ellos (p: 0.0000). El análisis univariado reveló que el Zubrod (p: 0.0000), el DHL (p: 0.0073), la remisión de la enfermedad (p: 0.0000), el estadio (p: 0.0000), el tratamiento (p: 0.0000), y la localización (p: 0.0000), tuvieron significancia estadística. El análisis multivariado mostró que en el modelo de regresión de Cox, la remisión (OR: 13.342, p: 0.0000), y la localización (OR: 2.375, p: 0.041), se encuentran dentro de la ecuación de dicha función. Conclusiones: Las lesiones ulceradas múltiples son características del Linfoma Gástrico. Se demuestra remisión de enfermedad en el Linfoma a células B de la zona marginal extranodal con antibioticoterapia (5/7). La quimioterapia en pacientes con EC I-II, alcanza resultados de supervivencia semejantes a la cirugía y a la combinación de ambas. Se confirma la validez del índice internacional y se demuestra en el análisis multivariado que la remisión y la localización de la enfermedad tienen significancia estadística. Introduction: Primary Gastric Lymphoma is an uncommon malignancy among gastric malignancies. Histology of the Primary Gastric Lymphoma is varied and the extranodal marginal zone B-cells lymphoma is specially significant on account of its potential remission with antibiotic therapy. Objectives: Observe the clinical characteristics of patients with Primary Gastric Lymphoma, assess the most relevant endoscopic findings, identify the factors that influence survival and evaluate the effects of therapy. Materials and Methods: The study is an observational, analytical, cross evaluation including 169 patients with histological diagnosis of Gastric Lymphoma, treated at the National Institute for Neoplastic Diseases, Lima, Peru, from January 1995 to December 2000. Staging was based on the Ann Arbor system, modified by Musshoff and histology, on the REAL-WHO classification. The statistical analysis included the student-t and the chi-square tests. Survival data were entered using the Kaplan Meier curves and prognosis factors, using the Cox regression test. Results: The sample represents patients from the Peruvian Coast, with a mean age of 55 years old and slight predominance of female patients (54.4%). Signs and symptoms are unspecific. Clinical stage I-II corresponds to 75% of the patients. The endoscopic pattern of multiple ulcerated lesions is characteristic of the Gastric Lymphoma. A total of 71% of the patients with extranodal marginal zone B-cells lymphoma showed total remission of the disease with antibiotic therapy (5/7). The histological type of the Gastric Lymphoma in the 169 patients was as follows: Large, diffuse, B-cells Lymphoma, 137 patients, extranodal marginal zone B-cells lymphoma, 16 patients, peripheral T-cell Lymphoma, 6 patients, anaplastic large T-cell Lymphoma, 3 patients, undetermined Lymphoma, 3 patients, mantle cell Lymphoma, 2 patients, adult T-cell Lymphoma, 1 patient and follicular Lymphoma, 1 patient. Global survival after 36 months was of 61.34%, survival according to the histological type was of 92.31% for extranodal marginal zone B-cells Lymphomas, 62.21% for large, diffuse B-cells Lymphomas and 29.63% for T-cell Lymphomas. Survival after 36 months in patients in clinical stage I-II treated with chemotherapy, was of 82.16%, with surgery, 71.89% and with surgery and chemotherapy, 70.39, with similar results in all three groups (p: 0.6530). The groups classified according to the international index, showed a clear difference between them (p:0.0000). The univariate analysis revealed that Zubrod (p:0.0000) DHL (p:0.0073) disease remission (p:0.0000) stage (p:0.0000) treatment (p:0.0000) and location (p:0.0000) had statistical significance. Multivariate analysis showed that in the Cox regression model, remission (OR:13,342, p:0.0000) and location (OR:2.375, p:0.041) fall within the equation of such function. Conclusions: The multiple ulcerated lesions are characteristic of the Gastric Lymphoma. Remission of the disease in the extranodal marginal zone B-cells Lymphoma is evidenced with the use of antibiotic therapy (5/7). Chemotherapy in patients with EC I-II achieves survival results similar to those treated with surgery and with a combination of both. Validity of the international index is confirmed and the multivariate analysis proved that remission and location of the disease have statistical significance.