RESUMO
A gastrosplenic fistula is a rare complication of gastric and splenic lymphomas which can occur spontaneously or secondary to chemotherapy. We report a case of a spontaneous gastrosplenic fistula secondary to a diffuse splenic large B cell lymphoma in a previously well 43-year-old patient. CT imaging demonstrated the fistula, which was subsequently managed with chemotherapy. The clinical management of this rare condition is discussed with a review of the literature.
Assuntos
Fístula/diagnóstico por imagem , Fístula/etiologia , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/etiologia , Interpretação de Imagem Assistida por Computador , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Esplenopatias/diagnóstico por imagem , Esplenopatias/etiologia , Neoplasias Esplênicas/complicações , Neoplasias Esplênicas/diagnóstico por imagem , Adulto , Anticorpos Monoclonais Murinos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Comportamento Cooperativo , Ciclofosfamida/administração & dosagem , Citarabina/administração & dosagem , Diagnóstico Diferencial , Doxorrubicina/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Fístula/tratamento farmacológico , Fístula/terapia , Fístula Gástrica/tratamento farmacológico , Fístula Gástrica/terapia , Humanos , Ifosfamida/administração & dosagem , Comunicação Interdisciplinar , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/terapia , Metotrexato/administração & dosagem , Equipe de Assistência ao Paciente , Intensificação de Imagem Radiográfica , Rituximab , Baço/diagnóstico por imagem , Baço/patologia , Esplenopatias/tratamento farmacológico , Neoplasias Esplênicas/tratamento farmacológico , Neoplasias Esplênicas/patologia , Neoplasias Esplênicas/terapia , Vincristina/administração & dosagemRESUMO
BACKGROUND & AIMS: Approximately 20% of hepatitis C virus (HCV) patients develop cirrhosis from infection after about 20 years. The proportion of patients developing cirrhosis for longer than 30 years after infection is unknown. Our objectives were to determine the prevalence of HCV-related cirrhosis in a population of Asian patients who were infected in childhood 20 to 80 years ago and compare this with the prevalence of cirrhosis in Caucasian patients referred to the same hospitals. METHODS: Retrospective analyses were performed of all patients who had detectable HCV-RNA levels and who attended local hospitals in northeast London between 1992 and 2003. Factors implicated in the development of cirrhosis were examined by multivariable analysis. RESULTS: A total of 143 adult Asian patients who had been infected with HCV for many decades were compared with 239 Caucasian patients. The prevalence of cirrhosis increased with age. Of Asian patients aged 61-80 years (n = 55) 78% had cirrhosis, whereas 25% of Caucasian patients aged 61-80 years (n = 55) had cirrhosis. Multivariable linear analysis revealed that fibrosis progression and age were similar in both groups and the difference in the prevalence of cirrhosis was not explained by any unique Asian characteristic other than prolonged infection. CONCLUSIONS: The prevalence of cirrhosis in patients with chronic HCV increases with increasing duration of infection. In Asian patients infected at birth, infection for over 60 years causes cirrhosis in 71% of infected individuals. Because relationship between the severity of fibrosis and age in Asian patients is similar to that seen in Caucasian patients it is likely that similar rates of cirrhosis will be seen in other patients who are infected for more than 60 years.