RESUMO
Laryngeal tuberculosis, although the most common granulomatous disease of the larynx, is a rare form of extrapulmonary tuberculosis, never reported in immunosuppressed allograft recipients. We present two cases of laryngeal tuberculosis in renal transplant patients and a review of the literature. Two women, a 29-year-old and a 60-year-old, each more than 9 years after their cadaveric renal allograft, presented with a 2-week febrile illness with hoarseness and dysphagia, and both were found to have laryngeal tuberculosis by direct laryngoscopy. Although both radiographs were unremarkable, both patients had sputum positive for acid-fast bacilli that subsequently grew Mycobacterium tuberculosis. Clinical response promptly followed institution of isoniazid, rifampicin, and pyrazinamide in each case, although both required threefold increases in daily cyclosporin A dosage to maintain therapeutic levels.
Assuntos
Transplante de Rim , Complicações Pós-Operatórias/diagnóstico , Tuberculose Laríngea/diagnóstico , Adulto , Antituberculosos/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Hospedeiro Imunocomprometido , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/imunologia , Fatores de Tempo , Transplante Homólogo , Tuberculose Laríngea/tratamento farmacológico , Tuberculose Laríngea/imunologiaRESUMO
A 22-year-old man with a history of repeated whole blood transfusions since the age of 7, was admitted to the hospital for dyspnea and blood-stained sputum. A complete blood cell count, a test for reticulin antibodies, an x-ray film of the chest, a transbronchial biopsy and a biopsy of the small bowel were performed and the results confirmed the diagnosis of IPH, associated with CD. The patient has been asymptomatic for four years on a gluten-free diet. In cases of IPH, it may be important to investigate the coexistence of CD because treatment of the latter could lead to a better prognosis.
Assuntos
Doença Celíaca/complicações , Hemossiderose/patologia , Pneumopatias/patologia , Adulto , Seguimentos , Hemossiderose/complicações , Humanos , Pulmão/patologia , Pneumopatias/complicações , MasculinoRESUMO
We describe a case of Horner's syndrome secondary to a thymic cyst. Following successful surgical removal of the cyst, the patient's symptoms resolved. To the best of our knowledge, a similar case has not been reported.
Assuntos
Síndrome de Horner/etiologia , Cisto Mediastínico/complicações , Síndrome de Horner/diagnóstico , Síndrome de Horner/cirurgia , Humanos , Masculino , Cisto Mediastínico/diagnóstico , Cisto Mediastínico/cirurgia , Pessoa de Meia-IdadeRESUMO
The aim of this study was to define the number of pleural biopsy samples necessary for optimum diagnostic performance and determine to what extent they are complementary. Eighty-four closed pleural biopsies were performed in our department between June 1996 and January 1998 on 55 males and 29 females with an average age of 64.4 +/- 16.7 years. The study of the pleural fluid included: pH, biochemical testing of pleura/serum (proteins, lactate dehydrogenase, glucose, cholesterol, triglycerides, albumin and adenosine deaminase), haemogram, cytology and microbiological testing (Gram-staining, aerobes, anaerobes and mycobacteriae cultures). The biopsies were performed using a Cope needle, with a total of five biopsies for each patient: four for pathological examination (taken numerically in the order in which they were performed: D1, D2, D3 and D4) and one for microbiological testing. In those cases in which the diagnosis was uncertain or effusion persisted, a thoracoscopy or thoracotomy was performed. There were no significant differences in the diagnostic yield of each individual sample (D1, D2, D3 and D4), but there were differences in the sum of the samples, depending on the number of biopsies performed.This was true for total group and the group with carcinomas, but not for the group with tuberculosis. The increase in diagnostic yield with the number of biopsies was more remarkable in the carcinoma cases, where it increased by 35% when four biopsies were performed (54% with one biopsy versus 89% with four biopsies, P < 0.002). In conclusion, the diagnostic yield increased with the number of biopsy samples in the total group and the group with malignancy but not in the group with tuberculous effusions. The best diagnostic performance for malignant pathology was obtained with four samples. In pleural tuberculosis, the diagnostic yield did not increase with more biopsy samples. One high quality sample should be enough to obtain a diagnosis.
Assuntos
Biópsia por Agulha/métodos , Pleura/patologia , Doenças Pleurais/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pleurais/patologia , Estudos Prospectivos , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Tuberculose Pleural/patologiaRESUMO
The case of a 70-year-old male with lymphoblastic leukemia is reviewed, who presented the rare and almost always fatal complication of pulmonary mucormycosis, but who was treated satisfactorily with amphotericin B and surgery. The risk of massive hemoptysis in the course of mucormycosis that invades the lung vessels, makes us believe that surgery is an essential part of the management of this disease. It is suggested that the patient be operated as soon as the diagnosis is obtained, as we did in our case, to avoid other risks in combined management with amphotericin B.
Assuntos
Broncopatias/cirurgia , Pneumopatias Fúngicas/cirurgia , Pulmão/irrigação sanguínea , Mucormicose/cirurgia , Idoso , Anfotericina B/uso terapêutico , Broncopatias/tratamento farmacológico , Broncopatias/imunologia , Terapia Combinada , Humanos , Hospedeiro Imunocomprometido , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/imunologia , Masculino , Mucormicose/tratamento farmacológico , Mucormicose/imunologiaRESUMO
We describe a 22-year-old man with a bone mass in the middle and lower third of the sternum with no signs of respiratory deterioration. After biopsy by incision established a diagnosis of hemangiosarcoma, appropriate resection and repair of the thoracic wall was scheduled. An adequate amount of tissue for analysis must be obtained to allow choice of a surgical technique that will assure the best prognosis in malignant tumors of the sternum and assignation of the most appropriate mechanical ventilation procedure.
Assuntos
Neoplasias Ósseas , Hemangiossarcoma , Esterno , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/cirurgia , Humanos , Masculino , Prognóstico , Radiografia , Esterno/diagnóstico por imagem , Esterno/cirurgiaRESUMO
We present a retrospective series of 27 nasopharyngeal carcinomas, selected from those attended at Ramón y Cajal Hospital between 1977 and 1996, with the aim of review the role of the study of Epstein-Barr virus in the diagnostic process of nasopharyngeal carcinoma. Twenty-seven patients, ranging from 14 to 81 years, with an average age of 50 years were selected. Male/female ratio was 1,7. All but one case were Caucasian. A neck mass was the first symptom in 40% of cases, with a mean diagnostic delay of 17 months. Only 8 cases (23%) did not exhibit neck nodes at the moment of diagnosis. CT and MRI were essential to establish staging: 5 stage I, 7 stage II and 15 stage IV, due to regional extension and/or bone erosion. Radiotherapy was employed in all cases, helped by chemotherapy in 20% of them. With a mean follow-up of 62 months, 5-years survival was 32% (IC 14,06-52,09). Of 27 cases of nasopharyngeal carcinoma 4 were differentiated (type I), 2 moderately differentiated (type II) and 22 undifferentiated (type III). While LMP-1 was only expressed by 41% of cases, PCR detected Epstein-Barr virus genome in 26 cases (96%) and in situ hybridization for EBERs was positive in all cases. Thus, all nasopharyngeal carcinomas were related to Epstein-Barr virus. Expression of LMP-1 seemed to worse the prognosis of nasopharyngeal carcinoma.
Assuntos
Carcinoma , Neoplasias Nasofaríngeas , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/diagnóstico , Carcinoma/radioterapia , Carcinoma/virologia , Feminino , Herpesvirus Humano 4/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/radioterapia , Neoplasias Nasofaríngeas/virologia , Estudos RetrospectivosRESUMO
We present a retrospective series of 16 cases of undifferentiated squamous carcinoma in cervical metastatic nodes of unknown primary. We review their clinical and radiological evaluation in search of a possible primary tumor, their response to treatment and the eventual development of a primary tumor. Furthermore, we study the presence of Epstein-Barr virus in the metastases as a predictor of their nasopharyngeal origin, in relation to the finding of primary lesions in the nasopharynx during further follow-up of the cases.
Assuntos
Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/virologia , Infecções por Herpesviridae/complicações , Herpesvirus Humano 4 , Neoplasias Nasofaríngeas/virologia , Neoplasias Primárias Desconhecidas , Infecções Tumorais por Vírus/complicações , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Feminino , Infecções por Herpesviridae/patologia , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/patologia , Pescoço , Neoplasias Primárias Desconhecidas/patologia , Estudos Retrospectivos , Infecções Tumorais por Vírus/patologiaAssuntos
Brassica , Gorduras na Dieta/efeitos adversos , Contaminação de Alimentos , Doenças Transmitidas por Alimentos/complicações , Pneumopatias/etiologia , Óleos/intoxicação , Choque Séptico/complicações , Doenças Vasculares/etiologia , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/patologia , Humanos , Pneumopatias/patologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Choque Séptico/etiologia , Espanha , Doenças Vasculares/patologiaRESUMO
A primary liposarcoma of the lung occurred in an 18 year old girl, the first to be reported in anyone under 40. Though rare, intrathoracic liposarcoma should be included in the differential diagnosis of pleural effusion in younger patients.
Assuntos
Lipossarcoma/patologia , Neoplasias Pulmonares/patologia , Adolescente , Diagnóstico Diferencial , Feminino , Humanos , Lipossarcoma/complicações , Lipossarcoma/diagnóstico , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Derrame Pleural/etiologiaRESUMO
Complete absence of C1q was demonstrated in the sera of 3 siblings in association with renal and cutaneous lesions. The serologic findings were consistent with an autoimmune disorder. Hematuria was the renal symptom present in all 3 patients; proteinuria was also present in 1. Renal biopsies showed mesangial proliferative glomerulonephritis with diffuse glomerular deposits of IgM and C3 in all cases. Clinical cutaneous manifestations and the histological picture were those of the Rothmund-Thompson syndrome. Three combined diseases, characterized by renal and cutaneous affection and serologic abnormalities, are presented in this paper.
Assuntos
Complemento C1/deficiência , Glomerulonefrite/genética , Miotonia Congênita/imunologia , Membrana Basal/análise , Membrana Basal/patologia , Biópsia por Agulha , Criança , Complemento C1/análise , Complemento C3/análise , Complemento C4/análise , Feminino , Imunofluorescência , Glomerulonefrite/imunologia , Humanos , Imunoglobulina M/análise , Glomérulos Renais/análise , Glomérulos Renais/patologia , Glomérulos Renais/ultraestrutura , Masculino , Pele/patologiaRESUMO
The association of bronchiolitis obliterans organizing pneumonia (BOOP) with insulin-dependent diabetes mellitus (IDDM) and Evans syndrome (autoimmune pancytopenia) has not been reported previously. We describe the case of a 4-year-old child diagnosed with IDDM and Evans syndrome who presented malaise, fever and nonproductive cough for several months. The chest radiograph revealed several patchy alveolar opacities with peripheral and bilateral distribution and multiple hilar and mediastinal adenopathies. An open lung biopsy established the diagnosis of BOOP. During the follow-up over the next 7 years, the patient had chronic relapses in spite of corticosteroid treatment and developed restrictive lung disease.
Assuntos
Doenças Autoimunes/complicações , Pneumonia em Organização Criptogênica/complicações , Diabetes Mellitus Tipo 1/complicações , Pancitopenia/complicações , Pré-Escolar , Pneumonia em Organização Criptogênica/patologia , Humanos , Pulmão/patologia , Masculino , SíndromeRESUMO
Histological demonstration of sarcoidosis affecting the paranasal sinus is rare in the clinical practice. In this paper, we present a case with a diagnosis of lupus pernio with extensive involvement of the nasal cavity and the right maxillary sinus. Long before being diagnosed as having lupus pernio, the patient had had a long history of nasal obstruction and had been treated surgically without success on 3 occasions. The literature on the topic is reviewed.
Assuntos
Seio Maxilar/patologia , Doenças Nasais/patologia , Doenças dos Seios Paranasais/patologia , Sarcoidose/patologia , Feminino , Humanos , Seio Maxilar/diagnóstico por imagem , Pessoa de Meia-Idade , Doenças Nasais/diagnóstico por imagem , Doenças dos Seios Paranasais/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Fourteen cases are revised of bronchiolalveolar carcinoma (BAC) diagnosed in our institution from 1980 to 1992. The time interval from clinical manifestations to diagnosis was 5.13 +/- 6.01 months. The incidence of smokers in the population was 42.8%. Clinical findings were non-specific, except in three cases, consisting in bronchorrhea with more than 100 ml. The most frequent site of the tumor was bilateral and diffuse (71%), mainly in nonsmokers. Endoscopic findings suggested a likely malignancy in 21% of cases. Transbronchial biopsy was the most sensitive diagnostic method. Histological confirmation was obtained in 85% of cases. To note the possible association with Epstein-Barr virus (EBV), as demonstrated by the findings of EBV genome in the cases when this study was performed.
Assuntos
Adenocarcinoma Bronquioloalveolar , Neoplasias Pulmonares , Adenocarcinoma Bronquioloalveolar/diagnóstico , Adenocarcinoma Bronquioloalveolar/etiologia , Adulto , Idoso , Broncoscopia , Feminino , Infecções por Herpesviridae/complicações , Herpesvirus Humano 4 , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/etiologia , Masculino , Pessoa de Meia-Idade , Fumar/efeitos adversos , Infecções Tumorais por Vírus/complicaçõesRESUMO
Bronchocentric granulomatosis (BG) is an uncommon pathologic finding characterized by necrotizing granulomas centered on bronchi and bronchioles. We report a nonasthmatic patient with a BG in whom no etiologic agent was identified. We discuss the different pathogenic mechanisms proposed in this group of patients.
Assuntos
Broncopatias/etiologia , Granuloma/etiologia , Adulto , Biópsia , Broncopatias/diagnóstico por imagem , Broncopatias/patologia , Feminino , Granuloma/diagnóstico por imagem , Granuloma/patologia , Humanos , Pulmão/patologia , Necrose , Radiografia TorácicaRESUMO
We report a patient with cirrhosis and hepatopulmonary syndrome. This syndrome is an entity characterized by anomalies in the arterial oxygenation in patients with chronic hepatic disease and/or portal hypertension and demonstration of pulmonary vasodilatation (PV) in absence of primary cardiac or pulmonary disease. We show that the finding of PV with transthoracic contrast enhanced echocardiography (TCEE) in the diagnosis of PV is real and corresponds to direct measurement of capillary diameter by morphometry.