ABSTRACT
Modelo de estudo: Relato de caso. Objetivo: Relatar o caso de um paciente com tumores gástricos sincrônicos e demonstrar a importância sobre o reconhecimento desta coexistência, tendo em vista que, normalmente, a sincronicidade só é detectada após o procedimento cirúrgico. Método: Estudo do prontuário médico do paciente pertencente ao Hospital do Servidor Público de São Paulo. Resultados: Apresentamos o caso de um paciente de 69 anos, sexo masculino, apresentando sintomas dispépticos, perda ponderal e astenia. Foram realizados exames laboratoriais, tomografia computadorizada e endoscopia digestiva alta. Os resultados demonstraram que se tratava da associação de duas lesões gástricas de aspectos diferentes, um adenocarcinoma gástrico com um tumor estromal gastrointestinal (GIST), próximos, todavia sem colisão. Conclusão: O paciente foi submetido a uma gastrectomia total com reconstrução em Y de Roux. Importância do problema: O câncer gástrico é a maior causa de mortalidade de natureza neoplásica, tendo em vista sua elevada frequência e por ser oligossintomático. Apesar de os dois serem muito diferentes quanto aos seus aspectos histopatológicos, podem ocorrer sincronicamente no estômago. É de grande importância a identificação pré-operatória da sincronicidade destes tumores, para um melhor aperfeiçoamento do planejamento cirúrgico. Comentários: No atual momento, ainda não há um exame específico para o rastreio de GIST, levando a dificuldade diagnóstica deste tumor. Neste caso, foi realizado o diagnóstico de adenocarcinoma, porém, apesar de ter sido evidenciado duas lesões gástricas distintas no exame de imagem, o diagnóstico final de GIST só pode ser feito com a análise anatomopatológica. (AU)
Objective: The aim of this report is to describe a case of a patient with synchronous gastric tumors and demonstrate the importance of identifying this coexistence before surgery, considering that synchronicity is generally detected only after the surgery. Methods: The medical records of patients from Servidor Público Estadual Hospital of São Paulo were analyzed. Results: We identified a case of a 69-year-old male patient who presented with symptoms of dyspepsia, weight loss, and asthenia. The patient underwent serum laboratory tests, abdominal computed tomography, and upper digestive endoscopy. Analysis of the results revealed that the symptomatology was related to the association of two different gastric lesions, gastric adenocarcinoma and a nearby gastrointestinal stromal tumor (GIST), although without collision. Conclusion: The patient was submitted to a total gastrectomy with a Y-en-Roux reconstruction. Importance of the problem: Gastric cancer is the major cause of mortality of neoplastic nature, considering its high frequency and presentation of few symptoms. Although gastric adenocarcinoma and GIST are extremely different in their histopathological aspects, they can occur synchronously in the stomach. Preoperative identification of the synchronicity of these tumors is significantly important to improve surgical planning. Comments: Currently, there is a lack of a specific examination for screening GISTs, which explains the difficulty in diagnosing this tumor before the surgical procedure. In the present case, the diagnosis of adenocarcinoma was made despite the fact that two distinct gastric lesions were detected in the radiological imaging examination, and the final diagnosis of GIST was made only through anatomopathological analysis.(AU)
Subject(s)
Humans , Male , Aged , Adenocarcinoma , Gastrointestinal Stromal Tumors , Neoplasms, Multiple Primary , Stomach NeoplasmsABSTRACT
Se presenta el caso de una paciente portadora de tres neoplasias sincrónicas diagnosticadas simultáneamente: un tumor de Brenner calcificado del ovario izquierdo, un carcinoma urotelial papilar de alto grado de la vejiga urinaria y un adenocarcinoma moderadamente diferenciado del pulmón derecho. Se practicó el tratamiento quirúrgico exerético de todos los tumores. Se administró un tratamiento de radioterapia más quimioterapia concurrente adyuvante para el tumor urotelial de la vejiga urinaria y otro esquema quimioterápico adyuvante para el adenocarcinoma pulmonar. No se presentaron complicaciones trans ni posoperatorias, ni como consecuencia de los tratamientos adyuvantes. Al momento de la presente publicación la paciente está viva y controlada de su enfermedad(AU)
The case of a patient with three simultaneously diagnosed synchronous neoplasms is presented: a calcified Brenner tumor of the left ovary, an advanced stage papillary urothelial carcinoma in the bladder, and a moderately differentiated adenocarcinoma to the right lung. The excisional surgical treatment of all tumors was performed. She had radiation treatment and concurrent adjuvant chemotherapy for transitional cell carcinoma of the urinary bladder and other adjuvant chemotherapy plan for lung adenocarcinoma. No intraoperative or postoperative complications occurred, or any other derivative effects of adjuvant treatments. At the time of this publication, the patient is alive and her disease is under control(AU)
Subject(s)
Humans , Female , Adenocarcinoma , Brenner Tumor/surgery , Lung Neoplasms/therapy , Neoplasms, Multiple Primary/drug therapy , Ovarian Neoplasms/surgery , Urinary Bladder Neoplasms/surgeryABSTRACT
CONTEXT: The presence of multiple neoplasms in one patient is an uncommon event. Its occurrence ranges from 1.2 percent to 4.5 percent of cancer patients in autopsy and clinical studies. In the present article, cases of synchronous diagnoses of carcinoma and lymphoid neoplasms are reported. The intention of this report was to alert clinicians and pathologists to the possibility of the existence of concomitant neoplasms, in order to prevent inaccurate or delayed diagnosis and staging. CASES:Seven patients (four female and three male) with a median age of 61.4 years were diagnosed as having concomitant epithelial and hematological neoplasms. DISCUSSION AND CONCLUSION: Lymph nodes should be carefully examined when searching for metastases, because of the possibility of a second hematological malignancy. Whenever uncommon suspicious morphological features are seen in such neoplasms, an immunohistochemical analysis is essential.
CONTEXTO: A presença de múltiplas neoplasias em um mesmo paciente é evento infreqüente, correspondendo a 1,2 por cento-4,5 por cento dos pacientes com câncer em estudos clínicos e de autópsias. Neste artigo, os autores relatam casos de diagnósticos sincrônicos de carcinomas e neoplasias linfóides. Ao apresentar estes casos, tenciona-se alertar clínicos e patologistas para a possibilidade da ocorrência de neoplasias concomitantes, para evitar atrasos ou erros diagnósticos ou de estadiamento da doença. SÉRIE DE CASOS:Sete pacientes, quatro mulheres e três homens, com média de idade de 61,4 anos, foram diagnosticados com neoplasias epitelial e hematológica concomitantes. DISCUSSÃO E CONCLUSÃO: Os linfonodos devem ser cuidadosamente examinados quando se buscam metástases, dada a possibilidade de uma neoplasia hematológica concomitante. Sempre que aspectos morfológicos suspeitos forem detectados, um estudo imunoistoquímico faz-se necessário.
Subject(s)
Adolescent , Aged , Female , Humans , Male , Middle Aged , Carcinoma/diagnosis , Lymphoma/diagnosis , Neoplasms, Multiple Primary/diagnosis , Carcinoma/therapy , Lymphoma/therapy , Neoplasms, Multiple Primary/therapy , Retrospective StudiesABSTRACT
La asociación de tumor epitelial y estromal maligno es muy infrecuente, habiendo pocos casos reportados, más infrecuente aún es la asociación de tumor epitelial maligno y tumor estromal benigno. Se presenta el caso de mujer de 65 años con diagnóstico preoperatorio de carcinoma endometrial, que durante el procesamiento de la pieza quirúrgica se encontró además una lesión intramural nodular estromal benigna, sin continuidad entre ambas lesiones.
The association of epithelial and stromal malignant neoplasm is very rare, with few reported cases, rarer still is the prescence of malignant epithelial tumor and stromal benign tumor. We present the case of women aged 65 with preoperative diagnosis of endometrial carcinoma, which in the pathological examination was found an intramural benign endometrial stromal lesión, without continuity between both tumors.