A 48-year-old male, with no relevant medical history except for one brain-brain injury 13 years earlier, who had undergone a craniotomy and urologic traumatism, L5-S1 discectomy and circumcision, right iron syndrome consultation.
Physical examination showed good general condition, without detecting masses after abdominal palpation.
Blood tests were normal except hemoglobin 10.5 g/dl, hematocrit 32.4 % and ESR at the first hour of 52 mm. Blood tumor markers CEA, Ca 19.9 and alpha-fetoprotein were normal.
renal contrast uptake and neoformative process, computed tomography (CT) scan of the liver and pelvis with contrast, showing a large mass of 20x24x14 cm, occupying the right hemiabdomen radial displacement
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Retroperitoneal mass with right kidney resection, ascending colon and head of pancreas was found. Retroperitoneal tumor resection was performed, associated with nephrectomy and right hemicolectomy.
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The histological study describes a tumor mass of 4,300 grams, with pancreatic abolished surface and hard consistency, located in the renal cortex and renal hilium fat, as well as ureter, colon wall and renal hilium.
Microscopically, it corresponds to a malignant tumor proliferation of mesenchymal origin, which grows with a predominantly synchronous pattern, consisting of intertwined collagen bundles and a multinucleoside connective tissue with numerous spindle cells.
Metastase areas of calcification and ossification are common in the tumor, as well as some foci of tumor necrosis.
The immunohistochemical profile of the tumor cells shows positivity for CD68 and Ki67, and negativity for desmin and actin.
These findings are compatible with the anatomopathological diagnosis of malignant fibrous histiocytoma pleo-storiformis.
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After the intervention, the patient remains in the resuscitation service for 24 hours with good evolution in the immediate postoperative period.
On the sixth day of hospitalization, the patient developed severe dyspnea, profuse sweating and cutaneous oxygen saturation, with axillary temperature 38.2 or C, blood pressure 117/68 mmHg, heart rate 125/75%.
Pulmonary auscultation revealed generalized hypoventilation. Blood analysis revealed leukocytosis of 22600 with 91% neutrophilia.
These findings motivate their admission to the Intensive Care Unit where it was decided to intubate orotracheally and mechanically, given the important respiratory work and the progressive oxygen desaturation.
A few minutes after intubation, the patient developed progressive bradycardia that was followed by electromechanic dilatation; therefore, advanced cardiopulmonary resuscitation was initiated.
During these episodes, there are several episodes of ventricular fibrillation that require electrical shocks, followed by asystole from which it is not recovered.
The patient died due to acute respiratory failure secondary to nosocomial pneumonia.
