RESUMO
INTRODUCTION: Muir-Torre syndrome is a genetic disease characterised by the association of sebaceous neoplasms with visceral neoplasms, mainly colorectal cancer and secondly urogenital tumours. Metastases from prostate tumours without systemic disease are rare in the brain and exceptional in the brainstem. CASE REPORT: We present a 48-year old male, with a single brainstem metastasis from a prostate adenocarcinoma, who had previously been diagnosed with Muir-Torre syndrome. Diagnostic stereotactic biopsy was performed. CONCLUSION: Single metastasis from a prostate adenocarcinoma in the brainstem without systemic disease is exceptional. Due to the different diagnostic possibilities, biopsy should be performed in order to obtain a diagnosis, especially in the context of Muir-Torre syndrome.
Assuntos
Adenocarcinoma/secundário , Biópsia , Neoplasias do Tronco Encefálico/secundário , Síndrome de Muir-Torre , Neoplasias da Próstata/patologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/genética , Adenocarcinoma/terapia , Adenoma/genética , Anilidas/administração & dosagem , Anilidas/uso terapêutico , Antineoplásicos Hormonais/administração & dosagem , Antineoplásicos Hormonais/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Tronco Encefálico/diagnóstico , Neoplasias do Tronco Encefálico/genética , Terapia Combinada , Docetaxel , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Muir-Torre/genética , Proteína 2 Homóloga a MutS/deficiência , Proteína 2 Homóloga a MutS/genética , Mutação , Neoplasias Primárias Múltiplas/genética , Neuronavegação/métodos , Nitrilas/administração & dosagem , Nitrilas/uso terapêutico , Prostatectomia , Neoplasias da Próstata/genética , Neoplasias da Próstata/terapia , Radioterapia Adjuvante , Neoplasias Retais/genética , Neoplasias do Colo Sigmoide/genética , Taxoides/administração & dosagem , Compostos de Tosil/administração & dosagem , Compostos de Tosil/uso terapêuticoRESUMO
BACKGROUND: There is evidence in the literature supporting that fluorescent tissue signal in fluorescence-guided surgery extends farther than tissue highlighted in gadolinium in T1 sequence magnetic resonance imaging (MRI), which is the standard to quantify the extent of resection. OBJECTIVE: To study whether the presence of residual fluorescent tissue after surgery carries a different prognosis for glioblastoma (GBM) cases with complete resection confirmed by MRI. METHODS: A retrospective review in our center found 118 consecutive patients with high-grade gliomas operated on with the use of fluorescence-guided surgery with 5-aminolevulinic acid. Within that series, the 52 patients with newly diagnosed GBM and complete resection of enhancing tumor (CRET) in early MRI were selected for analysis. We studied the influence of residual fluorescence in the surgical field on overall survival and neurological complication rate. Multivariate analysis included potential relevant factors: age, Karnofsky Performance Scale, O-methylguanine methyltransferase methylation promoter status, tumor eloquent location, preoperative tumor volume, and adjuvant therapy. RESULTS: The median overall survival was 27.0 months (confidence interval = 22.4-31.6) in patients with nonresidual fluorescence (n = 25) and 17.5 months (confidence interval = 12.5-22.5) for the group with residual fluorescence (n = 27) (P = .015). The influence of residual fluorescence was maintained in the multivariate analysis with all covariables, hazard ratio = 2.5 (P = .041). The neurological complication rate was 18.5% in patients with nonresidual fluorescence and 8% for the group with residual fluorescence (P = .267). CONCLUSION: GBM patients with CRET in early MRI and no fluorescent residual tissue had longer overall survival than patients with CRET and residual fluorescent tissue.
Assuntos
Ácido Aminolevulínico , Neoplasias Encefálicas/cirurgia , Corantes Fluorescentes , Glioblastoma/cirurgia , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/patologia , Feminino , Glioblastoma/mortalidade , Glioblastoma/patologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Prognóstico , Modelos de Riscos Proporcionais , Estudos RetrospectivosRESUMO
Introducción El síndrome de Muir-Torre es una enfermedad genética que se caracteriza por la aparición de neoplasias sebáceas con neoplasias viscerales y, en una menor incidencia, genitourinarias. Las metástasis cerebrales de tumores prostáticos sin evidencia de lesión sistémica son poco frecuentes y en el tronco cerebral son excepcionales. Caso clínico Presentamos un paciente de 48 años con una metástasis única en tronco cerebral de un adenocarcinoma prostático previamente diagnosticado de un síndrome de Muir-Torre. Se realizó por una biopsia estereotáctica para su diagnóstico. Conclusión La metástasis única de adenocarcinoma de próstata a nivel troncoencefálico sin afectación sistémica es prácticamente excepcional. Las posibilidades diagnósticas de inicio en el contexto de un síndrome de Muir-Torre obligan la realización de biopsia, y la estereotaxia es el método de elección (AU)