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1.
Gastroenterol. latinoam ; 34(2): 66-69, 2023. ilus
Artigo em Espanhol | LILACS | ID: biblio-1524724

RESUMO

Chronic diarrhea is a frequent cause of consultation in daily clinical practice. There are multiple diagnostic algorithms that allow a staggered approach to the most frequent pathologies, leaving out some lesser-known ones. This article reports the case of a 66-year-old female patient with a history of arterial hypertension, dyslipidemia and resected AB thymoma and a history of chronic diarrhea of 8 weeks of evolution. The etiological study ruled out infectious causes, celiac disease and negative viral serology. Due to a history of thymoma, immunoglobulin count was performed, showing severe pan-hypogammaglobulinemia. Good's Syndrome is the combination of thymoma and hypogammaglobulinemia, where patients may present with diarrhea secondary to immunodeficiency. Hypogammaglobulinemia associated with the presence of a thymoma is a rare cause but widely described in the literature as Good's Syndrome. Therefore, it seems relevant to describe a case, its approach and subsequent management.


La diarrea crónica constituye una causa frecuente de consulta en la práctica clínica diaria. Existen múltiples algoritmos diagnósticos que permiten realizar un abordaje escalonado de las patologías más frecuentes y permiten descartar algunas menos conocidas. En el presente artículo se reporta el caso de una paciente de género femenino de 66 años, antecedentes de hipertensión arterial, dislipidemia y timoma AB resecado con historia de diarrea crónica de 8 semanas de evolución. Dentro del estudio etiológico se descartan las causas infecciosas, enfermedad celíaca y serologías virales negativas. Por antecedente de timoma, se realizó recuento de inmunoglobulinas, evidenciando una severa pan-hipogammaglobulinemia. El Síndrome de Good es la combinación de timoma e hipogammaglobulinemia, donde los pacientes podrían presentar diarreas secundarias a inmunodeficiencia. La hipogammaglobulinemia asociada a la presencia de un timoma es una causa poco frecuente pero ampliamente descrita en la literatura como Síndrome de Good. Por lo antes señalado, nos parece relevante describir un caso, su abordaje y manejo posterior.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Timoma/complicações , Diarreia/etiologia , Síndromes de Imunodeficiência/etiologia , Síndrome , Timoma/diagnóstico , Agamaglobulinemia/etiologia , Agamaglobulinemia/terapia , Gastroenteropatias/etiologia , Síndromes de Imunodeficiência/terapia
2.
Medicina (B.Aires) ; 81(3): 478-481, jun. 2021. graf
Artigo em Espanhol | LILACS | ID: biblio-1346490

RESUMO

Resumen La enfermedad COVID-19, causada por el virus SARS-CoV-2, surgió a fines de 2019 en Wuhan, China. La evolución clínica es variable, así como la tasa de mortalidad, que es mayor en pacientes mayores de 65 años y en quienes padecen enfermedades subyacentes. Las inmunodeficiencias son potenciales factores de riesgo para formas graves de COVID-19. Los pacientes con inmunodeficiencias tienen además mayor frecuencia de complicaciones no infecciosas, que podrían representar un riesgo adicional. Hasta el momento existen escasas publicaciones sobre asociación COVID-19 e inmunodeficiencias humorales. Considerando la importancia del estudio de esta nueva enfermedad viral y de su potencial repercusión en la salud de los pacien tes con inmunodeficiencias presentamos seis casos de COVID-19 en adultos con déficit de anticuerpos (tres mujeres y tres varones, edad promedio 48.5 años, rango 20-67). Cuatro tenían inmunodeficiencias primarias: inmunodeficiencia común variable (n: 3) y agammaglobulinemia ligada al cromosoma X (n: 1). Los otro dos tenían hipogammaglobulinemia secundaria, en un caso asociada a timoma (síndrome de Good), y en el otro a tratamiento con rituximab. La evolución fue favorable en todos menos en el paciente con síndrome de Good, quien presentaba un marcado deterioro del estado general antes de contraer COVID-19.


Abstract COVID-19, caused by SARS-CoV-2, emerged in late 2019 in Wuhan, China. Its clinical course is variable, as well as the mortality rate, which is higher among people over 65 years of age and persons with underlying conditions. Immunodeficiencies are po tential risk factors for severe forms of COVID-19. Furthermore, patients with immunodeficiencies often undergo non-infectious complications, which could bear additional risk. So far, few reports of patients with COVID-19 and humoral immunodeficiencies have been published. Considering the importance of the study of this new viral disease and its potential health impact on patients with immunodeficiency disorders, we present six cases of COVID-19 in patients with impaired humoral immunity. Three were women and three were men. The average age was 48.5 years (range 20-67). Four had been diagnosed with primary antibody deficiency: three had common variable immunodeficiency and one had X-linked agammaglobulinemia. The other two patients had secondary hypogammaglobulinemia, one was associated with thymoma (Good's syndrome), and the other was associated with rituximab treatment. The evolution was favorable in all except the patient with Good's syndrome, who pre sented a marked decline in clinical status before contracting COVID-19.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Timoma , Neoplasias do Timo , Agamaglobulinemia , Doenças da Imunodeficiência Primária , COVID-19 , SARS-CoV-2
3.
Autops. Case Rep ; 11: e2021327, 2021. graf
Artigo em Inglês | LILACS | ID: biblio-1339246

RESUMO

Thymomas are a heterogeneous group of tumors arising from the epithelium of the thymus. They are categorized by the proportion of neoplastic epithelia to lymphocytes and by the degree of cytologic atypia. Thymomas constitute 0.2-1.5% of all malignancies and nearly all occur in patients over 20 years. We reviewed the available literature and found less than 50 cases of thymoma reported in children (<18 years of age), the youngest being 4 years old, and no cases in newborns. They represent less than 1% of all mediastinal tumors in children. Due to the limited number of cases in the pediatric population, the diagnosis and treatment in this population is extremely challenging. Thymomas in all age groups may be associated with paraneoplastic syndromes, being myasthenia gravis the most common, which is associated with a worse prognosis in the pediatric population. We present the first case of a newborn infant with congenital thymoma. This case demonstrates a rare tumor in an unusual age group and emphasizes the importance of multidisciplinary teamwork in the decision-making and management of this condition.


Assuntos
Humanos , Masculino , Recém-Nascido , Timoma/congênito , Neoplasias do Timo/congênito , Timo , Hiperplasia do Timo , Anormalidades Congênitas/patologia , Miastenia Gravis
4.
Rev. ANACEM (Impresa) ; 15(1): 49-54, 2021. ilus
Artigo em Espanhol | LILACS | ID: biblio-1281435

RESUMO

INTRODUCCIÓN: Los tumores de mediastino constituyen una entidad clínica poco frecuente, generalmente asintomática. Se pueden desarrollar desde estructuras que se ubican en el compartimento anterior, medio y posterior, siendo la primera, la ubicación más usual. En los adultos, timomas y linfomas (Hodgkin y no Hodgkin) son las masas más comunes del mediastino anterior, junto al bocio endotorácico y los teratomas; todas en su conjunto son conocidas como las "4 T del Mediastino Anterior". Casos clínicos: Se exponen tres casos clínicos de tumores de mediastino anterior, intervenidos en nuestro centro. Discusión: Las masas mediastínicas constituyen una entidad clínica infrecuente. La tomografía computada de tórax con y sin contraste intravenoso es utilizada para evaluar estas anormalidades descubiertas radiográficamente. El diagnóstico definitivo generalmente requiere una muestra de tejido que se obtiene mediante biopsia antes del tratamiento o como parte de una resección terapéutica planificada de toda la masa. En Chile, existen pocos trabajos recientes que muestren las características clínicas de pacientes que presentan timomas o linfomas; es por esto que se hace importante la presentación de estos casos que constituyen un aporte al conocimiento nacional.


INTRODUCTION: Mediastinal tumours constitute a clinical entity infrequent, generally asymptomatic. It can develop from structures localized on anterior compartment, middle and posterior, where structure localized on anterior compartment is usual. Adults tend to have thymomas and lymphomas more common in anterior mediastinal within intrathoracic goiter and teratomas. They are known as a "4T of anterior mediastinal mass". Clinical cases: Three clinical cases of anterior mediastinal tumours are exposed in our centre. Discussion: Mediastinal mass constitutes a clinical entity infrequent. The computed Tomography of the thorax with intravenous contrast and without intravenous contrast are used to evaluate abnormalities discover by radiography. The final diagnosis requires a fabric sample which is obtained by a biopsy before the treatment or as a part of a planned therapeutic recession. In Chile exist a few recently studies that shows clinical characteristics of patients which presents thymus and lymphomas as a result is important to present this kind of cases due to these cases constitute to the national knowledge.


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Timoma/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Neoplasias do Mediastino/diagnóstico por imagem , Doença de Hodgkin , Toracotomia , Tomografia Computadorizada por Raios X , Hospitais Públicos , Linfoma/terapia , Neoplasias do Mediastino/cirurgia
5.
Artigo em Português | LILACS | ID: biblio-1358911

RESUMO

RESUMO: Relatamos o caso de um paciente do sexo feminino, 76 anos, com tosse há seis meses. Os exames laboratoriais estavam normais. Na radiografia do tórax observou-se alargamento do mediastino no terço médio do tórax. Posteriormente, foram realizadas tomografia computadorizada e ressonância magnética do tórax que caracterizaram uma massa localizada no mediastino anterior, envolvendo a aorta ascendente e comprimindo a veia cava superior. O diagnóstico histológico pós-biópsia e ressecção parcial da lesão foi de um carcinoma tímico de células escamosas. (AU)


ABSTRACT: We report the case of a female patient, 76 years old, with a cough for six months. Laboratory tests were normal. Chest X-ray revealed enlargement of the mediastinum in the middle third of the thorax. Later, computed tomography and magnetic resonance imaging of the thorax were performed, characterizing a mass located in the anterior mediastinum, involving the ascending aorta and compressing the superior vena cava. Histological diagnosis after biopsy and partial resection of the lesion was a thymic squamous cell carcinoma. (AU)


Assuntos
Humanos , Feminino , Idoso , Timoma/diagnóstico por imagem , Biópsia , Imageamento por Ressonância Magnética , Neoplasias do Mediastino
6.
J. bras. pneumol ; 46(1): e20180315, 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1056624

RESUMO

ABSTRACT Objective: To evaluate the results of resection of tumors of the thymus by robotic thoracic surgery, analyzing the extent of resection, postoperative complications, time of surgery, and length of stay. Methods: Retrospective study from a database involving patients diagnosed with a tumor of the thymus and undergoing robotic thoracic surgery at one of seven hospitals in Brazil between October of 2015 and June of 2018. Results: During the study period, there were 18 cases of resection of tumors of the thymus: thymoma, in 12; carcinoma, in 2; and carcinoid tumor, in 1; high-grade sarcoma, in 1; teratoma, in 1; and thymolipoma, in 1. The mean lesion size was 60.1 ± 32.0 mm. Tumors of the thymus were resected with tumor-free margins in 17 cases. The median (interquartile range) for pleural drain time and hospital stay, in days, was 1 (1-3) and 2 (2-4), respectively. There was no need for surgical conversion, and there were no major complications. Conclusions: Robotic thoracic surgery for resection of tumors of the thymus has been shown to be feasible and safe, with a low risk of complications and with postoperative outcomes comparable to those of other techniques.


RESUMO Objetivo: Avaliar os resultados da ressecção de tumores tímicos por cirurgia torácica robótica, verificando a radicalidade da ressecção, complicações pós-operatórias, tempo de cirurgia e tempo de internação. Métodos: Estudo retrospectivo a partir de um banco de dados envolvendo pacientes com diagnóstico de tumor tímico e submetidos à cirurgia torácica robótica em sete hospitais no Brasil entre outubro de 2015 e junho de 2018. Resultados: Durante o período estudado, houve 18 casos de ressecção de tumores tímicos (timomas, em 12; carcinoma tímico, em 2; e tumor carcinoide tímico, sarcoma tímico de alto grau, teratoma tímico e timolipoma, em 1 cada). A média do tamanho das lesões foi de 60,1 ± 32,0 mm. Tumores tímicos foram ressecados com margens livres em 17 casos. As medianas (intervalos interquartis) de tempo de dreno pleural e de internação, em dias, foram 1 (1-3) e 2 (2-4), respectivamente. Não houve necessidade de conversão cirúrgica nem complicações maiores. Conclusões: A cirurgia torácica robótica para a ressecção de tumores tímicos demonstrou ser factível e segura, com baixo risco de complicações e desfechos pós-operatórios comparáveis aos de outras técnicas.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Tomografia Computadorizada por Raios X , Estudos Retrospectivos , Resultado do Tratamento
8.
Odovtos (En línea) ; 21(2): 33-44, May.-Aug. 2019. graf
Artigo em Espanhol | LILACS, BBO - Odontologia | ID: biblio-1091479

RESUMO

RESUMEN Los timomas son las neoplasias mediastínicas más comunes en adultos. Los pacientes con timoma son frecuentemente diagnosticados con síndromes paraneoplásicos y generalmente están asociados con varias condiciones autoinmunes. El síndrome de Sjögren (SS) es un trastorno inflamatorio autoinmune, que se caracteriza por la destrucción mediada por linfocitos de las glándulas exocrinas, que conduce a la ausencia de secreción glandular, en particular las salivales y las lagrimales; la hiposalivación puede variar desde una ligera reducción en el flujo de saliva con molestias transitorias, a un grave deterioro de la salud oral y malestar psicológico. El penfigoide de membranas mucosas (PMM) es una enfermedad autoinmune crónica, muestra predominante afectación de la mucosa, afectando con mayor frecuencia la cavidad oral, seguida de la conjuntiva, la cavidad nasal y el esófago; intraoralmente incluye gingivitis descamativa, vesículas, erosiones cubiertas por pseudomembranas y úlceras. El objetivo de este trabajo es presentar el primer caso de una paciente con antecedente de timoma, la cual, conjuntamente presentó SS y PMM; además evidenciar la importancia del manejo multidiciplinario para un diagnóstico preciso y temprano, ya que así, aumenta la eficiencia y la eficacia de la estrategia de tratamiento.


ABSTRACT Thymomas are the most common mediastinal neoplasms in adults. Patients with thymoma are frequently diagnosed with paraneoplastic syndromes and are generally associated with several autoimmune conditions. Sjögren's syndrome (SS) is an autoimmune inflammatory disorder, characterized by the lymphocyte-mediated destruction of the exocrine glands, which leads to the absence of glandular secretion, particularly salivary and lacrimal; hyposalivation can vary from a slight reduction in the flow of saliva with transient discomfort, to a serious deterioration of oral health and psychological distress. Mucous membrane pemphigoid (MMP) is a chronic, autoimmune disease that shows predominant mucosal involvement, most commonly affecting the oral cavity, followed by the conjunctiva, the nasal cavity and the esophagus; intraorally includes scaly gingivitis, vesicles, erosions covered by pseudomembranes and ulcers. The objective of this work is to present the first case of a patient with a history of thymoma, which, jointly presented SS and MMP; also highlight the importance of multidisciplinary management for an accurate and early diagnosis, as this increases the efficiency and efficacy of the treatment strategy.


Assuntos
Humanos , Feminino , Adulto , Timoma/diagnóstico , Xerostomia , Síndrome de Sjogren/complicações , Penfigoide Mucomembranoso Benigno/diagnóstico , Candidíase
9.
Rev. méd. Chile ; 147(4): 518-521, abr. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1014254

RESUMO

Klinefelter syndrome (47, XXY in most cases) is a frequently underdiagnosed chromosomal anomaly associated with multiple comorbidities in adult life. Patients with Klinefelter syndrome have a higher risk of cancer. Specifically, these patients have a higher risk for mediastinal germ cell tumors. It is estimated that 8% of male patients with mediastinal tumors have Klinefelter. We report a 42-years-old male who suffered recurrent respiratory infections. During the study, a mediastinal mass was found, whose pathological study disclosed a type B thymoma. The patient had a history of infertility, high stature, gynecomastia, obesity with gynecoid distribution of body fat and testicular atrophy. A karyotype was requested (47, XXY), confirming the diagnosis of Klinefelter syndrome.


Assuntos
Humanos , Masculino , Adulto , Timoma/patologia , Neoplasias do Timo/patologia , Síndrome de Klinefelter/patologia , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico , Radiografia Torácica , Tomografia Computadorizada por Raios X , Síndrome de Klinefelter/diagnóstico , Síndrome de Klinefelter/genética , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/patologia
11.
Medisan ; 22(9): 961-969, nov.-dic. 2018. []
Artigo em Espanhol | LILACS | ID: biblio-976175

RESUMO

Se presenta el caso clínico de un paciente de 50 años de edad, quien acudió a la consulta de Oncología del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, por presentar un tumor tímico de 4 meses de evolución. Se le realizó timectomía y linfadenectomía mediastinal, así como una biopsia que indicó la presencia de carcinoma tímico de tipo linfoepitelioma (II) de alto grado de malignidad, estadio IVA; por tal razón se decidió efectuar tratamiento con quimioterapia y radioterapia. Debido a la persistencia del tumor se planificó la segunda línea de quimioterapia, pero el paciente falleció.


The case report of a 50 year-old patient is presented who visited the Oncology department of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, due to a 4 months thymic tumor. A thymectomy and mediastinal lymphadenectomy were carried out , as well as a biopsy which indicated the presence of thymic carcinoma, type II lymphoepithelioma of high degree of malignancy, stage IV A; for such a reason it was decided to carry out a treatment with chemotherapy and radiotherapy. Due to the tumor persistence the second chemotherapy line was planned, but the patient died.


Assuntos
Humanos , Masculino , Adulto , Timectomia , Timoma/patologia , Neoplasias do Timo , Radioterapia , Biópsia de Linfonodo Sentinela , Excisão de Linfonodo
12.
Rev. bras. oftalmol ; 77(3): 153-155, May-June 2018. graf
Artigo em Português | LILACS | ID: biblio-959085

RESUMO

Resumo A Síndrome de Good é uma síndrome paraneoplásica caracterizada pela associação de timoma e hipogamaglobulinemia, cursando com imunossupressão. Relatamos um caso raro de retinite por citomegalovírus em paciente com esta síndrome.


Abstract Good syndrome is a paraneoplastic syndrome characterized by the association of thymoma and hypogammaglobulinemia, with immunosuppression. We report a rare case of cytomegalovirus retinitis in a patient with this syndrome.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Timoma/complicações , Retinite por Citomegalovirus/etiologia , Agamaglobulinemia/complicações , Retina/diagnóstico por imagem , Doenças Retinianas/diagnóstico por imagem , Timoma/imunologia , Imunoglobulina G/sangue , Acuidade Visual , Ganciclovir/administração & dosagem , Ganciclovir/uso terapêutico , Retinite por Citomegalovirus/diagnóstico , Retinite por Citomegalovirus/tratamento farmacológico , Citomegalovirus/imunologia , Agamaglobulinemia/imunologia , Técnicas de Diagnóstico Oftalmológico , Administração Intravenosa
15.
Rev. colomb. reumatol ; 24(3): 193-195, jul.-set. 2017.
Artigo em Espanhol | LILACS | ID: biblio-900876

RESUMO

Resumen Las miopatías inflamatorias y, principalmente, las dermatomiositis se asocian en un porcentaje significativo de los casos a procesos tumorales. Presentamos un caso de asociación poco habitual de dermatomiositis con timoma en una paciente sin factores de riesgo de miopatía paraneoplásica, en ausencia de miastenia gravis y con una evolución tórpida a pesar de la resección de la masa mediastínica.


Abstract Inflammatory myopathies, especially dermatomyositis, can be associated with tumour formation. The case is reported of a rare combination of dermatomyositis and thymoma in a patient with no risk factors of paraneoplastic myopathy. The patient progressed slowly despite resection of the mediastinal mass.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Miosite , Doenças Autoimunes , Timoma , Dermatomiosite , Miastenia Gravis
16.
Rev. colomb. reumatol ; 23(3): 204-209, jul.-set. 2016. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-960212

RESUMO

Describimos el caso de un paciente masculino de 41 años que cursa con cuadro clínico de dolor torácico, astenia y adinamia, con estudios imagenológicos que evidencian masa en mediastino anterior que corresponde a timoma, de acuerdo con el reporte de patología. Además cursa con anemia hemolítica e hipotiroidismo autoinmune, sin miastenia gravis asociada


The case is presented of a 41 year-old male patient with chest pain, asthenia and adynamia. The imaging studies showed a mass in the anterior mediastinum, which according to the pathology report, was a thymoma. Also, the patient also had haemolytic anaemia and autoimmune hypothyroidism, and with no associated myasthenia gravis


Assuntos
Humanos , Timoma , Autoimunidade , Anemia Hemolítica
17.
Acta méd. costarric ; 57(4): 190-194, oct.-dic. 2015. tab, ilus
Artigo em Espanhol | LILACS | ID: lil-778041

RESUMO

Objetivo: Valorar los resultados obtenidos con 38 pacientes intervenidos por tumores del timo.Método:se estudió a todos los pacientes intervenidos por tumores del timo durante el periodo de 1996 a 2013 en el Hospital "Dr. Rafael Ángel Calderón Guardia".Resultados:se intervino a 38 pacientes por tumores del timo en los 17 años evaluados, 20 hombres y 18 mujeres con promedio edad de 50 años. En 26 casos se realizó resección, la cual en 19 fue macroscópicamente completa. Se reportó 20 tumores malignos y 18 benignos. De los 20 casos con tumores malignos, a 9 pacientes se les realizó resección, en 6 la resección fue completa y en 3 incompleta, y a 11 solamente biopsia. 16 de los 20 casos con tumores malignos recibieron quimioterapia. De los casos con tumores malignos 15 tenían más de 5 años de establecido el diagnóstico, y de estos 7 se encontraban vivos, lo que corresponde a una sobrevida a 5 años de un 47%. Los timomas representaron un 17% de todos los tumores del mediastino. Los síntomas manifestados por los pacientes se debieron a la compresión causada por el tumor.Conclusiones:el método de detección más útil fue la radiografía de tórax. La vía más utilizada para tomar biopsia fue mediastinotomía. La quimioterapia desempeño un papel importante en la sobrevida, ya que pacientes con resección incompleta, se encontraron vivos hasta 5 años después del diagnóstico. La conducta que mostró ser más efectiva para los timomas malignos fue, reseccióncompleta complementada con quimioterapia.


Aim: To evaluate the results obtained from 38 patients undergoing surgery for tumors of the thymus at the Hospital Calderon Guardia.Method:All patients undergoing surgery for tumors of the thymus during the period 1996-2013 were studied.Results:38 patients underwent surgery for tumors of the thymus in the 17 years evaluated, 20 men and 18 women, with an average age of 50 years. In 26 cases resection was performed, which was macroscopically complete in 19. Of the 38 tumors, 20 were reports as malignant and 18 as benign. Of the 20 cases with malignant tumors, in 9 patients a resection was performed, in 6 resection was complete and in 3 incomplete, and 11 only had a biopsy; 16 of the 20 patients with malignant tumors received chemotherapy. Of the cases with malignant tumors 15 had over 5 years of the diagnosis, and of these 7 were alive, which corresponds to a 5 year survival of 47%. Thymomas accounted for 17% of all mediastinal tumors. The symptoms manifested by patients were due to compression caused by the tumor.Conclusions:The chest radiography was the most useful screening method. The route most used to take biopsy was mediastinotomy. Chemotherapy played an important role in survival as patients with incomplete resection were found alive five years after diagnosis. The treatment shown to be more effective for malignant thymoma was complete resection complemented with chemotherapy.


Assuntos
Humanos , Masculino , Adulto , Feminino , Costa Rica , Tratamento Farmacológico , Neoplasias do Mediastino , Radiografia Torácica , Timoma , Neoplasias do Timo
18.
Clinics ; 70(12): 775-780, Dec. 2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-769705

RESUMO

OBJECTIVE: The role of chemotherapy in treating advanced thymic carcinoma is unclear. The purpose of the current study was to investigate the efficacy of chemotherapy and the prognostic factors for patients with advanced thymic carcinoma. METHODS: A retrospective review of the medical records of 86 patients treated with chemotherapy for advanced thymic carcinoma was conducted between 2000 and 2012 at our institution. The clinical characteristics, chemotherapy regimens and prognostic factors were analyzed. Survival curves were plotted using the Kaplan-Meier method and the Cox proportional hazard model was used for multivariate analysis. RESULTS: Of the 86 patients, 56 were male and 30 were female. The median survival time was 24.5 months. For the first-line chemotherapy treatment, the objective response rate was 47.7% and the disease control rate was 80.2%. The median progression-free survival for all patients was 6.5 months for first-line chemotherapy. No significant differences in progression-free survival were observed among the different chemotherapy regimens. Multivariate analyses revealed that the prognostic factors for overall survival included performance status (p=0.043), histology grade (p=0.048), and liver metastasis (p=0.047). CONCLUSION: Our results suggest that there is no difference in efficacy between multiagent and doublet regimens. The prognosis of patients with advanced thymic carcinoma can be predicted based on histological grade, liver metastasis and performance status.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antineoplásicos/uso terapêutico , Timoma/tratamento farmacológico , Neoplasias do Timo/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/secundário , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Timoma/mortalidade , Timoma/patologia , Neoplasias do Timo/mortalidade , Neoplasias do Timo/patologia
19.
Biomédica (Bogotá) ; 35(4): 475-479, oct.-dic. 2015. tab
Artigo em Espanhol | LILACS | ID: lil-768077

RESUMO

Introducción. La miastenia grave es una enfermedad autoinmunitaria mediada por anticuerpos. Entre 10 y 15 % de quienes la padecen tienen timoma y su presencia se asocia con una mayor gravedad de los síntomas, crisis miasténicas y fracaso del tratamiento de primera línea. La timectomía se recomienda en pacientes jóvenes con miastenia grave generalizada y en todos los pacientes con timoma. Caso clínico. Se presenta el caso de una mujer de 43 años que, en el 2005, presentó una primera crisis miasténica asociada con un timoma invasor que se trató con timectomía y radioterapia. Durante los siguientes tres años, presentó síntomas graves y dos crisis más, que obligaron a suministrarle respiración mecánica asistida e inmunoglobulina. Al cabo del tratamiento, no se evidenciaron signos de recurrencia en las tomografías de tórax con contraste. Entre el 2009 y el 2012, la gravedad de los síntomas fue menor. En el 2013, estos se exacerbaron y una resonancia magnética de tórax con contraste reveló una lesión en el mediastino anterior, ya observada en el 2011, sugestiva de tejido residual o fibrosis. Se inició el tratamiento usual con inmunoglobulina y se hizo una tomografía por emisión de positrones cuyos resultados no fueron concluyentes, por lo que se llevó a cabo una nueva resección y se constató que no había recurrencia del tumor. Conclusiones. Los pacientes con miastenia grave y aquellos con timoma asociado, deben someterse a la timectomía como parte del tratamiento. Sin embargo, la exacerbación de los síntomas o su reaparición después del procedimiento no necesariamente implica una nueva alteración en el timo.


Introduction: Myasthenia gravis is an antibody-mediated autoimmune disease. Approximately 10-15% of patients present with a thymoma, the presence of which is associated with greater severity of symptoms, myasthenic crisis, and irresponsiveness to front-line therapy. A thymectomy is recommended in young patients with generalized myasthenia gravis and in all patients presenting with thymoma. Clinical case: The patient was a 43-year-old woman, who first showed symptoms of myasthenic crisis in 2005 and presented with invasive thymoma managed with thymectomy and radiotherapy. In the subsequent three years, the patient presented with severe symptoms and two myasthenic crises that required mechanical ventilation and immunoglobulin treatment. Contrast chest computed tomography examinations showed no recurrence. Between 2009 and 2012, the patient experienced decreased symptom severity. In 2013, the patient presented with an exacerbation of symptoms; a contrast chest magnetic resonance scan showed a lesion in the anterior mediastinum, previously observed in 2011, suggestive of residual tissue as opposed to fibrosis. Regular management was started with immunoglobulins; a positron emission tomography scan was inconclusive, requiring a new resection, which showed no evidence of tumor recurrence. Conclusions: Patients with myasthenia gravis and those with myasthenia-related thymoma both share thymectomy as an element of treatment. However, following the procedure, exacerbation or reappearance of symptoms does not necessarily represent new alterations in the thymus.


Assuntos
Adulto , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Timectomia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Miastenia Gravis/etiologia , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/diagnóstico por imagem , Timoma/patologia , Timoma/radioterapia , Neoplasias do Timo/patologia , Neoplasias do Timo/radioterapia , Imageamento por Ressonância Magnética , Terapia Combinada , Progressão da Doença , Tomografia por Emissão de Pósitrons , Diagnóstico Diferencial , Mediastino/diagnóstico por imagem , Miastenia Gravis/cirurgia , Miastenia Gravis/tratamento farmacológico , Miastenia Gravis/diagnóstico por imagem , Invasividade Neoplásica , Recidiva Local de Neoplasia/diagnóstico
20.
Rev. chil. cardiol ; 34(1): 66-71, abr. 2015. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-749430

RESUMO

Se presenta un paciente de 60 años, chagásico crónico y usuario de marcapasos definitivo con masa en aurícula derecha asociada a Síndrome de Vena Cava Superior y baja de peso.


A 69 year old man, with Chagas Disease and an implanted pacemaker develop a superior vena cava syndrome and weight loss.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Timoma/patologia , Neoplasias do Timo/patologia , Síndrome da Veia Cava Superior , Átrios do Coração/patologia , Invasividade Neoplásica
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