RESUMEN
Parathyroid carcinoma is a very rare oncological entity, presenting insidiously in the second and fourth decades of life, characterized by hypercalcemia and hyperparathyroidism of difficult control, accompanied by general malaise, complications secondary to hypercalcemia and cervical tumor, being the main differential diagnosis of parathyroid adenoma. Complementing imaging studies of neck, scintigraphy, and contrast neck computed tomography. The diagnostic suspicion of parathyroid carcinoma is usually confirmed by the pathology of the surgical specimen. The surgery of choice is parathyroidectomy plus ipsilateral thyroidectomy. Monitoring of hypercalcemia and hyperparathyroidism is performed.
El carcinoma paratiroideo es una afección oncológica muy infrecuente, que se presenta de manera insidiosa en la segunda y cuarta décadas de la vida. Su clínica se caracteriza por hipercalcemia e hiperparatiroidismo de difícil control, y se acompaña de malestar general, complicaciones secundarias a la hipercalcemia y tumoración cervical, siendo el principal diagnóstico diferencial el adenoma paratiroideo. Son necesarios estudios de imagen, como ecografía de cuello, gammagrafía y tomografía computarizada de cuello con contraste. La sospecha diagnóstica de carcinoma paratiroideo usualmente se confirma con el estudio de patología de la pieza quirúrgica. La cirugía de elección es la paratiroidectomía más tiroidectomía homolateral. Se realiza seguimiento para el control de la hipercalcemia y del hiperparatiroidismo.
Asunto(s)
Adenoma , Hiperparatiroidismo , Neoplasias de las Paratiroides , Adenoma/complicaciones , Adenoma/diagnóstico por imagen , Adenoma/cirugía , Humanos , Hiperparatiroidismo/cirugía , Neoplasias de las Paratiroides/complicaciones , Neoplasias de las Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía , TiroidectomíaRESUMEN
Coccidioidomycosis is a fungal disease caused by Coccidioides immitis or Coccidioides posadasii. These fungi are endemic in the southern USA and northern Mexico. Immunocompromised patients are susceptible to develop severe forms of this fungal infection. Cytokines play an important role in controlling the fungal infection, but little is known about the predominant immunological environment in human lung tissue from fatal cases. Our aim was to analyze the pro-inflammatory and anti-inflammatory cytokines and monocyte/macrophages markers (CD14 and CD206) in the granulomas of six fatal cases of coccidioidomycosis. Cytokines and surface markers were higher in coccidioidomycosis cases when compared to control (P < 0.05). CD14 positive cells were increased inside the coccidioidal granuloma when compared to the outside (P < 0.05). No differences were found in the number of CD206+ cells inside the granuloma when compared to the outer population (P > 0.05). Interestingly, an analysis of stain intensity signals showed an increased signaling of CD14, CD206, IL-10 and TNFα inside the granuloma when compared to the outside (P < 0.05). iNOS and IL-12 gene expression were not detected in coccidioidomycosis cases, while IL-10, IL-6 and TGFß gene expression were detected, but the differences when compared to healthy lungs were not significant (P > 0.05). TNFα gene expression was lower in coccidioidomycosis cases when compared to healthy lung (P = 0.05). In conclusion, pro- and anti-inflammatory responses co-exist inside of the granulomas of fatal cases of coccidioidomycosis and the absent of iNOS and IL-12 gene expression may be related with patient's outcome.
