RESUMO
Multiple myeloma is a malignant plasma cell proliferation located in the bone marrow and bones. It can secondarily manifest with extraosseous involvement, but the gastro-intestinal tract locations are rare. We report 3 cases of gastric and colonic localizations of myeloma in two males and one female, aged 66, 71 and 77years. Multiple myeloma had been diagnosed 1 to 7years before. Digestive symptoms were epigastric pain, rectal bleeding or an obstructive syndrome. Endoscopy revealed ulcerated and budding tumors in the stomach, and nodular pseudo-polypoid tumor formations or an ulcerated erythematous area in the colon. Histopathological examination of the biopsies showed a diffuse tumor cell proliferation in the lamina propria composed of cells with a plasmacytoid or plasmablastic appearance, expressing plasma cell markers such as CD138 on immunohistochemistry. The 3 patients died in the weeks following the diagnosis. The prognosis of digestive localizations of multiple myeloma remains very poor despite new therapies. In the presence of any digestive symptoms in these patients with multiple myeloma, more systematic endoscopy may allow an earlier diagnosis and the implementation of more effective therapies.
Assuntos
Neoplasias do Colo , Mieloma Múltiplo , Neoplasias Gástricas , Humanos , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/patologia , Idoso , Masculino , Feminino , Neoplasias do Colo/patologia , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/complicações , Neoplasias Gástricas/patologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/complicações , Evolução FatalRESUMO
Sudden death (SD) in young, apparently healthy athletes under 35 is an underestimated public health problem in Belgium. This is dramatically illustrated by the case of a 28-year old ultra-trail runner who suffered cardiac arrest during training, revealing an unrecognized cardiomyopathy. This highlights the importance of pre-participation cardiovascular screening in identifying such hidden conditions. The variety of causes of SD, mainly of cardiac origin, underlines the complexity of screening and the need to tailor it to the specific risks of each individual. The central issue in screening is the relevance of the resting 12-lead electrocardiogram (ECG). While some countries have adopted it with positive results, others continue to debate its systematic inclusion. Sudden death affects not only professional athletes, but also amateurs, who are often less medically monitored. The aim of cardiovascular screening is twofold: to identify young people at risk, while not unnecessarily limiting access to sport for those with no cardiac pathology. The effectiveness of the ECG is well recognized, but the implementation of such systematic screening in Belgium must take into account certain practical aspects.
La mort subite (MS) chez les jeunes sportifs de moins de 35 ans, en bonne santé apparente, est une problématique de santé publique sous-estimée en Belgique. Cette réalité est dramatiquement illustrée par le cas d'un ultra-traileur de 28 ans, victime d'un arrêt cardiaque lors d'un entraînement, révélant une cardiomyopathie méconnue. Cela met en lumière l'importance d'un dépistage cardiovasculaire pré-participatif pour identifier de telles affections cachées. La variété des causes de MS, principalement d'origine cardiaque, souligne la complexité du dépistage et la nécessité de l'adapter en fonction des risques spécifiques à chaque individu. La question centrale du dépistage est la pertinence de l'électrocardiogramme (ECG) à 12 dérivations de repos. Tandis que certains pays l'ont adopté avec des résultats positifs, d'autres continuent de débattre sur son inclusion systématique. La MS n'affecte pas que les athlètes professionnels, mais aussi les amateurs, souvent moins suivis sur le plan médical. L'objectif du dépistage cardiovasculaire est double : identifier les jeunes à risque, tout en ne limitant pas inutilement l'accès au sport pour ceux dépourvus de pathologie cardiaque. L'efficacité de l'ECG est reconnue, mais la mise en Åuvre d'un tel dépistage systématique en Belgique doit tenir compte de certains aspects pratiques.