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El linfoma de células T en adultos (ATLL) es una neoplasia agresiva de linfocitos T, por lo general asociada con el virus linfotrópico T humano tipo 1 (HTLV-1), de presentación clínica abigarrada. Los linfomas gástricos primarios son generalmente linfoma no Hodgkin (NH) tipo B, y un mínimo porcentaje por linfocitos T. Es escasa la literatura sobre linfomas gástricos primarios por células T con HTLV-1 Negativo y que hacen metástasis ósea. Para ilustrar esta situación, se presenta el caso de un adulto de 41 años, que ingresa por una fractura patológica. A los 15 días presenta diarrea, distensión abdominal, y una endoscopia alta encuentra "Lesiones ulceradas gástricas, aspecto neoproliferativo". La biopsia informó Linfoma No Hodgkin a células maduras linfocito T; y la prueba de HTLV1 fue negativa. Se realizaron tres sesiones de quimioterapia con esquema CHOEP. Hubo respuesta favorable, saliendo de alta; sin embargo, no retorna para proseguir la terapia. El paciente regresó dos meses después en mal estado general; luego presentó falla multiorgánica, produciéndose su deceso.
Adult T-cell lymphoma (ATLL) is an aggressive T-cell neoplasm, usually associated with human T-lymphotropic virus type 1 (HTLV-1), with a variegated clinical presentation. Primary gastric lymphomas are generally non-Hodgkin lymphoma (NH) type B, and a minimal percentage are due to T lymphocytes. There is little literature on primary gastric lymphomas due to HTLV-1 Negative T cells that metastasize to bone. To illustrate this situation, the case of a 41-year-old adult who is admitted for a pathological fracture is presented. 15 days later, he developed diarrhea and abdominal distension, and an upper endoscopy found "gastric ulcerated lesions, neoproliferative appearance". The Biopsy reported Non-Hodgkin Lymphoma to mature T lymphocyte cells; and the HTLV1 test was negative. Three chemotherapy sessions were performed with the CHOEP scheme. There was a favorable response, and he was discharged; However, he did not return to continue therapy. The patient returned 2 months later in poor general condition. He then presented multiple organ failure, resulting in his death.
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Complicações Neoplásicas na Gravidez , Neoplasias Gástricas , Feminino , Humanos , GravidezRESUMO
Introduction: Mixed histology tumours are rarely found in the stomach. Of these, collision tumours are mainly composed of adenocarcinomas and sarcomas or lymphomas. This is the seventh case reported in the literature of an acinar cell carcinoma arising from an ectopic pancreas located in the stomach and the first described within a collision tumour. Clinical case: We present the case of a 58-year-old female patient diagnosed with gastric cancer who, after undergoing a total gastrectomy, presented with a pathology report describing findings compatible with gastric collision tumour with components of tubular adenocarcinoma and acinar cell carcinoma of probable pancreatic ectopic aetiology. Discussion: At the beginning of the 20th century, collision tumours were rarely described. Those located in the stomach are an infrequent pathology and are rarely diagnosed preoperatively. A collision tumour is composed of two independent neoplastic tissue with tumour areas separated in two different histological patterns and, in case of metastasis, this separation must also be clearly identified. There are different theories about its carcinogenesis and the debate regarding the ideal treatment is still ongoing. Conclusion: This is the first report of a malignant gastric tumour with probable heterotopic pancreatic origin that collides with gastric adenocarcinoma.
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RESUMEN Objetivo. Evaluar la importancia de las biopsias óseas en el diagnóstico de las enfermedades óseas metabólicas, su relación con la densitometría ósea (DMO) y los biomarcadores. Métodos. Estudio transversal, descriptivo. Se efectuaron biopsias de la cresta pelviana a 38 personas, 36 mujeres (34 menopáusicas y 2 premenopáusicas) y 2 varones. DMO en columna vertebral, cadera y/o antebrazo por absorciometría dual de rayos X. Se determinó calcio, fósforo, osteocalcina, fosfatasa alcalina, vitamina D, parathormona, hemoglobina, transaminasas, proteínas totales y fracciones en sangre y en orina, N-telopéptido de enlaces de colágeno tipo I, calcio y fósforo por métodos convencionales. Resultados. La edad promedio de 34 mujeres postmenopáusicas fue 58 ± 7,79 y el tiempo de la menopausia 11,48 ± 8,76 años; la DMO promedio en columna, cadera y antebrazo fue de -2,88 ± 1,16, -2,13 ± 0,82, y -5,14 ± 1,76, respectivamente; la biopsia demostró osteoporosis en 33 y enfermedad de Paget en 1. Dos varones de 48 y 63 años, con DMO en antebrazo de -3,2 y -4,9, y osteoporosis en la biopsia. Mujer de 34 años con DMO -3 y osteoporosis en biopsia; y una mujer de 29 años con DMO -3 y osteomalacia en biopsia. Hubo correlación negativa entre la edad y duración de la menopausia con la disminución de la DMO. Conclusiones. Hubo correlación entre la edad y tiempo de menopausia con la disminución de la DMO. Una DMO baja no siempre es osteoporosis, puede tratarse de otra enfermedad ósea metabólica como osteomalacia o enfermedad de Paget. La biopsia ósea es el procedimiento más confiable para el diagnóstico de estas enfermedades.
ABSTRACT Objective. To evaluate the importance of bone biopsy in the diagnose of the bone metabolic diseases, its relationship with bone densitometry (BMD) and biomarkers. Methods. In a descriptive, transversal study, 38 biopsies of pelvic bone were made, 36 in female (34 postmenopausal and 2 premenopausal) and 2 in male. All had BMD in spine, hip and/or forearm measured by dual x-ray absorptiometry. Calcium, phosphorus, parathormone, vitamin D, alkaline phosphatase, osteocalcin, hemoglobin, transaminases, total protein and fractions were measured in blood and N-telopeptide of collagen type I, calcium and phosphorus in urine by conventional methods. Results. The mean age of 34 menopausal women was 58 ± 7,79 and menopause time was 11,48 ± 8,76 years; mean BMD in spine, hip and forearm were -2,88 ± 1,16, -2,13 ± 0,82, y - 5,14 ± 1,76, respectively; bone biopsy demonstrated osteoporosis in 33 y Paget´s disease in one. Male persons 48 and 63 years old had BMD in forearm -3,2 and -4,9, and osteoporosis in biopsy. A woman 34 years old had a BMD of -3 and osteoporosis en bone biopsy, a woman 29 years old with BMD -3 presented osteomalacia in biopsy. There was a negative correlatión between age and time of menopause with BMD decrease. Conclusions. A negative correlation between the age and time of menopause with BMD decrease was found. A low BMD not always is osteoporosis, it might be other bone metabolic disease like osteomalacia or Paget´s disease. Bone biopsy is a more trustworthy procedure for the diagnose of these diseases.
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Introducción: En nuestro medio no existen estudios que evaluen los diversos marcadores de recambio óseo en mujeres con osteoporosis posmenopáusica, considerando la alta tasa de morbimortalidad asociada a las fracturas por fragilidad. Objetivo: Conocer las características bioquímicas del metabolismo óseo en mujeres posmenopáusicas con osteoporosis. Métodos: Estudio transversal. Se incluyeron a 49 mujeres posmenopáusicas con osteoporosis, a quienes se midió la densidad mineral ósea por absorciometría dual de rayos X en columna lumbar, cadera y antebrazo. Se determinó calcio, fósforo, osteocalcina, fosfatasa alcalina, vitamina D y paratohormona en sangre y en orina, N-telopéptido de enlaces de colágeno tipo I, calcio y fósforo por métodos convencionales. Resultados: La edad promedio fue 59,1 ± 7,5 años. El tiempo medio de menopausia fue 12,0±7,9 años. Todas tuvieron osteoporosis en antebrazo, 55,1%, en columna lumbar y 18,4%, en cadera total. Valores insuficientes de vitamina D tuvo el 46,9% y 8,2, valores deficientes. La osteocalcina fue normal en 73,5%, disminuida en 20,1% y alta en 6,4%. Se encontró correlación positiva entre la edad y la concentración de paratohormona, y negativa con la vitamina D. La fosfatasa alcalina tuvo correlación positiva con la duración de la menopausia. Conclusión: La mayor extensión de osteoporosis tuvo correlación con la edad y tiempo de menopausia. Más de la mitad de mujeres tuvieron niveles bajos de vitamina D.
Introduction: In our context, there are no studies which had evaluated the markers of bone turnover in post menopausal women with osteoporosis, considering the high rate of morbidity and mortality associated with fragility fractures. Objective: To know the biochemical features of bone metabolism in women with postmenopausal osteoporosis. Methods: A cross-sectional study. 49 women with postmenopausal osteoporosis were included. Bone mineral density in spine, hip and forearm was measured by dual x-ray absorptiometry. Calcium, phosphorus, osteocalcin, alkaline phosphatase, vitamin D and paratohormone were measured in blood. N-telopeptide of collagen type I, calcium and phosphorus were measured in urine by conventional methods. Results: The average age of the participants was 59,1± 7,5 years. The average time since menopause was 12,0 ± 7,9 years. All had osteoporosis in forearm; 46,9% had insufficient levels of vitamin D and 8,2% had deficient values. The osteocalcin was normal in 73,5%, decreased in 20,1% and increased in 6,4% participants. Age showed statistically significant correlation with serum parathyroid hormone and was negatively correlated with vitamin D. The time of menopause had a positive and statistically significant correlation with alkaline phosphatase. Conclusion: The extension of osteoporosis had a positive correlation with older age and longer menopause. The bone turnover markers provide complementary information to bone densitometry.
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BACKGROUND: Malignant pleural mesothelioma (MPM) is an aggressive tumor, associated with poor prognosis. There is a lack of information about the clinical and pathological features related with survival in the Latin American population. METHODS: The MeSO-CLICaP registry identified 302 patients with advanced MPM diagnosed and treated between January 2008 and March 2016. The Cox model was applied to determine the variables associated with survival. A random forest tree model was built to predict the response to first-line chemotherapy among Latin American patients. RESULTS: The median age was 61.1 years (SD 10.6 years), 191 (63.2%) were men, 65.9% were ever smokers, and 38.7% had previous exposure to asbestos. A total of 237 (78.5%) had epithelioid tumors, and 188 (62.3%) and 114 (37.7%) cases had stage III or IV MPM, respectively. A total of 49 patients (16.2%) underwent pleurectomy, 57 (18.9%) received radiotherapy, and 279 patients received first-line platinum-based chemotherapy. The overall response rate to first-line chemotherapy was 40.4%, progression-free survival to first-line treatment was 5.7 months (95% CI 4.9-6.5), and 63 (20.8%) patients had pemetrexed maintenance. The median overall survival was 16.8 months (95% CI 13.0-20.5), and multivariate analysis found that stage (P = 0.013), and pleurodesis (P = 0.048), were independent prognostic factors for first-line overall survival. The model to predict response to first-line chemotherapy obtained a 0.98 area under the curve, a sensitivity of 93%, and a specificity of 95% for detecting responders and non-responders. CONCLUSION: This study identifies factors associated with clinical benefit from chemotherapy among advanced MPM Latin American patients, emphasizing the impact of histology and the clinical benefit of chemotherapy on outcomes.
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Neoplasias Pulmonares/epidemiologia , Mesotelioma/epidemiologia , Platina/uso terapêutico , Neoplasias Pleurais/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/uso terapêutico , Feminino , Humanos , América Latina/epidemiologia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Mesotelioma/tratamento farmacológico , Mesotelioma/patologia , Mesotelioma/cirurgia , Mesotelioma Maligno , Pessoa de Meia-Idade , Pemetrexede/uso terapêutico , Neoplasias Pleurais/tratamento farmacológico , Neoplasias Pleurais/patologia , Neoplasias Pleurais/cirurgia , Intervalo Livre de Progressão , Procedimentos Cirúrgicos Torácicos/métodosRESUMO
The differential diagnosis for lymphadenopathy is wide and clinical presentations overlap, making obtaining an accurate diagnosis challenging. We sought to characterize the clinical and radiological characteristics, histological findings, and diagnoses for a cohort of patients with lymphadenopathy of unknown etiology. 121 Peruvian adults with lymphadenopathy underwent lymph node biopsy for microbiological and histopathological evaluation. Mean patient age was 41 years (Interquartile Range 26-52), 56% were males, and 39% were HIV positive. Patients reported fever (31%), weight loss (23%), and headache (22%); HIV infection was associated with fever (P < 0.05) and gastrointestinal symptoms (P < 0.05). Abnormalities were reported in 40% of chest X-rays (N = 101). Physicians suspected TB in 92 patients (76%), lymphoma in 19 patients (16%), and other malignancy in seven patients (5.8%). Histological diagnoses (N = 117) included tuberculosis (34%), hyperplasia (27%), lymphoma (13%), and nonlymphoma malignancy (14%). Hyperplasia was more common (P < 0.001) and lymphoma less common (P = 0.005) among HIV-positive than HIV-negative patients. There was a trend toward reduced frequency of caseous necrosis in samples from HIV-positive than HIV-negative TB patients (67 versus 93%, P = 0.055). The spectrum of diagnoses was broad, and clinical and radiological features correlated poorly with diagnosis. On the basis of clinical features, physicians over-diagnosed TB, and under-diagnosed malignancy. Although this may not be inappropriate in resource-limited settings where TB is the most frequent easily treatable cause of lymphadenopathy, diagnostic delays can be detrimental to patients with malignancy. It is important that patients with lymphadenopathy undergo a full diagnostic work-up including sampling for histological evaluation to obtain an accurate diagnosis.
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Linfadenopatia/diagnóstico , Linfadenopatia/patologia , Adulto , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PeruRESUMO
Varón de 84 años agricultor, diagnosticado el 2001 de anemia megaloblástica asociada a deficiencia de vitamina B12, polineuropatía sensitivo-motora en miembros inferiores y atrofia gástrica (AG) con metaplasia intestinal. Fue tratado con combinaciones de ácido fólico 1000 mcg y cianocobalamina 8mcg, mejora y normaliza cifras de hemoglobina trás 2 meses de terapia. Un año después, abandona el tratamiento, por sentirse mejor. La anemia y la signología de polineuropatía sensitivo motora con inadecuada percepción gustativa de los sabores normales reaparecen el 2008. Por esta época los estudios demuestran : pancitopenia, anemia megaloblástica severa, deficiencia de Vit B12, atrofia gástrica, pólipos y xantomas en la superficie gástrica, metaplasia intestinal, alteraciones de lípidos séricos, xerosis facial y máculas blancas (2-3 mm) generalizadas. Recibió tratamiento con cianocobalamina parenteral, el paciente persiste (2012) con su AG, aunque la polineuropatía sensitivo-motora desapareció y sus niveles de hemoglobina son normales.
We present the case of an 84-year old male farmer, who was diagnosed in 2001 with megaloblastic anemia associated to vitamin B12 deficiency, sensory-motor polyneuropathy in his lower limbs and gastric atrophy with intestinal metaplasia. The patient was tr eated with a combination including 1000 mcg folic acid and 8 mcg cyanocobalamin. He impr oved his hemoglobin levels back to normal after 2 months of therapy. One year later, he stooped therapy because he was feeling better. In 2008, anemia and the sensorial motor polyneuropathy reappeared, together with an inadequate perception of normal flavor. At this time studies showed the following: pancytopenia, severe megaloblastic anemia, vitamin B12 deficiency, gastric atrophy, gastric polyps and xanthomas, intestinal metaplasia, serum lipid abnormalities, facial xerosis and generalized white spotted macular lesions (2-3 mm). He was treated with parenteral cyanocobalamin, and the patient now still has gastric atr ophy, although the sensorial-motor polyneuropathy had disappeared and his hemoglobin levels are once again normal.
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Humanos , Masculino , Idoso de 80 Anos ou mais , Anemia Megaloblástica , Anemia Perniciosa , Gastrite AtróficaRESUMO
Varón de 36 años con diagnóstico de infección VIH-1 por siete años y sin tratamiento que presentó convulsiones generalizadas en los últimos cinco meses y marcada baja de peso. Se le halló hemiparesia izquierda y rigidez de nuca moderada disartria y un tumor palpable frontoparietal derecho. La tomografía reveló un tumor de 11 x 9 cm en la zona frontal, con edema peritumoral que comprimía los ventrículos laterales y desviaba la línea media en más de 5 mm. La biopsia reveló un linfoma primario difuso, a células B grandes, VEB (+), CD 20 (+), Ki 67:80%. El conteo de CD4 fue 9 células/mm3 y la carga viral VIH fue 54 352 copias/mL. Fue tratado con TARGA, mejorando su condición general y disminuyendo las convulsiones.
A 36 year-old man with a 7-year diagnosis of HIV infection and without treatment had generalized seizures during the last five months and, besides, marked weight loss. On examination, he had a left hemiparesis and nuchal rigidit, dysarthria and a palpable tumor in the right frontoparietal area. CT-scan revealed a right front-parietal tumor of 11 x 9 cm in the frontal area with peritumoral edema compressing the lateral ventricles and more than 5 mm midline deviation. A brain biopsy showed a primary lymphoma (diffuse large B-cell), EBV (+), CD 20 (+), Ki 67:80%., cd4: 9 cells/mm3, HIV viral load: 54352 copies/mL. He was treated with highly antiretroviral therapy (HAART) alone and his general condition improved and the seizures diminished.
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Humanos , Masculino , Adulto , HIV , Linfoma Relacionado a AIDS , Sistema Nervoso CentralRESUMO
Varón de 50 años, con 7 meses de enfermedad caracterizada por mialgias, astenia, y malestar general. cinco meses antes de ingresar al Hospital Dos de Mayo (HNDM), desarrolla derrame pleural derecho que requiere drenaje pleural (1500-2500 cc/día). Internado en el HNDM se descubre un derrame pleural bilateral con incremento de triglicéridos. Una tomografía espiral multicorte (TEM), de tórax con contraste demostró adenopatías mediastinales, derrame pleural bilateral, liquido al interior de la pleura mediastinal derecha posterior adyacente a D10-D11-D12, e imagen osteolítica en cuerpo vertebral de D11. Una biopsia de ganglio axilar izquierdo, reveló un Linfoma no Hodgkin (LNH), folicular de células grandes y pequeñas. Estando sometido a una dieta alta en triglicéridos de cadena media y aceite de oliva como suplemento el paciente recibió quimioterapia (Dexametasona, Ciclofosfamida, Doxorrubicina, Vincristina), siendo dado de alta después del primer ciclo, con programación de quimioterapias cada 3 semanas y toracocentesis evacuatorias periódicas condicionales. Después de 5 meses de tratamiento, el quilotórax bilateral desapareció.
This is the story of a 50 year-old male subject with a 7-month illness characterized by myalgia, fatigue, and malaise. 5 months before being admitted to Dos de Mayo National Hospital (HNDM), he developed right pleural effusion requiring pleural drainage (1500-2500 mL/day).While in HNDM, the patient developed bilateral pleural effusion with increased triglycerides. A multiple-slice contrast spiral CT (TEM) of the chest showed mediastinal lymph node enlargement, bilateral pleural effusion, and the presence of fluid within the right posterior mediastinal pleura adjacent to D10-D11-D12, and an osteolytic image in D11 vertebral body. A left axillary lymph node biopsy revealed non-Hodgkin lymphoma (NHL), follicular type with large and small cells. The patient received a diet rich in medium-chain triglycerides and olive oilas a supplement, and he also received chemotherapy (dexamethasone, cyclophosphamide, doxorubicin, vincristine), being discharged after the first cycle. Chemotherapy was scheduled to be administered every 3 weeks, and drainage thoracentesis were also scheduled to be performed during his probation period. After 5 months of treatment, bilateral chylothorax disappeared.