RESUMO
Amyotrophic lateral sclerosis (ALS) with atypical symptoms poses a diagnostic challenge to clinicians, frequently resulting in delayed diagnosis. The patient reported here presented with unexplained weight loss and was investigated for 8 months, with an extensive work-up, including several imaging studies, especially to rule out neoplastic processes, before a diagnosis of ALS could be made, largely on the basis of upper and lower motor weakness.
Assuntos
Esclerose Lateral Amiotrófica/diagnóstico , Esclerose Lateral Amiotrófica/terapia , Biópsia , Eletroencefalografia , Eletromiografia , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologiaRESUMO
BACKGROUND: Osteosarcomas, despite their aggressive nature and propensity to metastasize, only rarely give rise to skin deposits. CASE: We report a case of a femoral osteosarcoma in which cutaneous scalp and neck metastases developed 3 years after treatment of the primary disease. Fine needle aspiration was pivotal in diagnosing the secondary disease. CONCLUSION: Only 8 instances of cutaneous metastases from an osteosarcoma have been previously reported. We recommend early investigation of such nodules with fine needle aspiration cytology and inclusion of multiagent chemotherapy as part of the treatment protocol in all patients with osteosarcoma.