Percorrer por autor "Portugal, Margarida"
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- Is fluoroscopy necessary for oesophageal SEMS placement? A retrospective cohort studyPublication . Relvas, Luís Miguel; Gago, Tânia; Barros, Sónia; Carvalho, Isabel; Portugal, Margarida; Velasco, Francisco; Caldeira, Paulo; Peixe, BrunoIntroduction: self-expanding metal stents (SEMS) are widely used for the palliation of malignant esophageal conditions, including strictures, fistulas, and extrinsic compression. Placement may be guided by fluoroscopy, direct endoscopy, or both. However, few studies have directly compared the outcomes of these techniques. Objective: to compare the safety and efficacy of SEMS placement under endoscopic versus fluoroscopic control in a real-world clinical setting. Methods: we conducted a retrospective observational study of adult patients who underwent esophageal SEMS placement between January 2011 and December 2023. Patients were assigned to either the endoscopic control (EC) or fluoroscopic control (FC) group based on fluoroscopy availability. Outcomes included technical success, complication rates (early and late), and overall survival. Results: a total of 103 patients were included (mean age 69.4 years; 79 % male), with 43 receiving SEMS under EC and 60 under FC. The primary indication was malignant esophageal stricture (91.3 %). Technical success was achieved in 97 % of EC cases and 100 % of FC cases. Early complications occurred in 53 % of EC and 49 % of FC patients (p = 0.70), including chest pain (40.7 %), vomiting (22.3 %), and stent migration (5.8 %). Late complications occurred in 28 % of EC and 31 % of FC cases (p = 0.74), most commonly tumor overgrowth (14.6 %) and stent migration (10.7 %). Thirty-day mortality was 2.3 % in the EC group and 0 % in the FC group (p = 0.31). Median survival was 102 days (EC) versus 113 days (FC) (p = 0.44). Conclusions: SEMS placement under both endoscopic and fluoroscopic control is safe and effective, with no significant differences in complication rates, technical success, or survival. Endoscopic guidance may be a viable alternative to fluoroscopy in experienced hands, particularly in resource-limited settings.
- Verrucous carcinoma of the esophagus: a deceiving entity with an uncertain etiology – case reportPublication . Carvalho, Isabel Malta; Gago, Tânia; Relvas, Luís; Portugal, Margarida; Cadilla, Jesus; Peixe, BrunoVerrucous carcinoma of the esophagus is an extremely rare malignancy, described as a well-differentiated variant of esophageal squamous cell carcinoma, typically exhibiting exophytic/verrucous growth and intraluminal involvement that is often rich in inflammation and hyperkeratosis, which hampers histologic diagnosis and consequently delays treatment. We report the case of a 58-year-old woman with progressive dysphagia and a circumferential, verrucous esophageal lesion, without histologic confirmation despite multiple biopsies and endoscopic resections, showing only focal p16 positivity. After further evaluation with CT, endoscopic ultrasound, and FDG-PET/CT, a presumptive diagnosis of locally advanced verrucous carcinoma of the esophagus was assumed, and palliative chemotherapy was initiated, followed by a sustained endoscopic and radiologic response. This case highlights the importance of multidisciplinary discussion when verrucous carcinoma of the esophagus is suspected and the unexpected, sustained response despite unresectability.
- Widespread metastatic uveal melanoma with gastrointestinal and gallbladder involvement: a case reportPublication . de Oliveira, Raquel; Portugal, Margarida; Roseira, Joana; Peixe, BrunoMelanoma is a malignant tumour arising from melanocytes, with cutaneous melanoma accounting for the vast majority of cases. Less frequently, melanomas originate from extracutaneous melanocytes, including those of the uveal tract. Although primary gastrointestinal melanomas exist, gastrointestinal involvement by melanoma more commonly represents metastatic disease. Recognition of gastrointestinal metastatic lesions and their variable endoscopic appearance has become increasingly relevant with the advances in systemic therapies. Case Presentation: We report a case of a 74-year-old man referred for investigation of irondeficiency anaemia. Esophagogastroduodenoscopy revealed multiple flat, dark millimetric lesions in the distal oesophagus, stomach, and duodenum. Histopathological examination with immunohistochemistry revealed melanoma. Cross-sectional imaging and positron emission tomography demonstrated widespread metastatic disease involving the liver, lungs, brain, bone, and gallbladder, as well as a hypermetabolic intraocular lesion. Ophthalmological and dermatological evaluation was consistent with primary uveal melanoma, with no evidence of a cutaneous primary. The patient experienced rapid neurological deterioration due to brain metastases and died shortly after diagnosis. Conclusion: Gastrointestinal metastases of melanoma are rare, particularly in uveal melanoma, and are often clinically silent. Endoscopic findings are heterogeneous and may be detected during the investigation of nonspecific symptoms such as anaemia. This case highlights the importance of recognising and sampling atypical pigmented gastrointestinal lesions, as endoscopy may play a key role in the diagnosis of advanced melanoma and prompt multidisciplinary management.