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1.
Int. j. morphol ; 42(2): 446-451, abr. 2024. ilus
Artigo em Inglês | LILACS | ID: biblio-1558137

RESUMO

SUMMARY: Experimental studies devoted to the study of the mechanisms of the pathogenesis of acute peritonitis and the development of new methods of medical and surgical treatment are becoming increasingly relevant. Today, experimental medicine knows many different ways to modeling septic peritonitis and eliminate it, but the role of the local immune system is underestimated, whereas it takes a direct part in inflammation. The objective of our work to study morphological features of results of experimental modeling of septic peritonitis in white rats. The study included 15 sexually mature white male rats weighing 276.75±6.56 grams. A simulation of septic peritonitis was performed by perforating the upper part of the cecum with four punctures with a G16 injection needle. As a result of the experiment, after examination of the peritoneal cavity, all 15 animals were diagnosed with omentum tamponade of perforated damage to the caecum. In 11 cases, the perforated wall of the caecum was covered by the greater omentum (73.34 %), and in the other 4 animals, tamponade was performed by one of the epididymal omentum (26.66 %). The initial stage of tamponade with the greater or epididymal omentums of a perforated caecum begins on the first day of the experiment and consists of tight interstitial consolidation between them, as well as in the invasion of blood vessels from the omentum side to the focus of infection, which ensure the delivery of the appropriate immunocompetent cells. As a result of this process, intensive lymphoid infiltrates are formed in this area, as well as the growth of adipose tissue, which isolates the inflammatory focus from the peritoneal cavity with a thick layer.


Las investigaciones experimentales dedicadas al estudio de los mecanismos de patogénesis de la peritonitis aguda y el desarrollo de nuevos métodos de tratamiento médico y quirúrgico son cada vez más relevantes. Hoy en día, la medicina experimental conoce muchas formas diferentes de modelar la peritonitis séptica y eliminarla, pero se subestima el papel del sistema inmunológico local, mientras que él participa directamente en la inflamación. El objetivo de nuestro trabajo fue estudiar las características morfológicas de los resultados del modelado experimental de peritonitis séptica en ratas blancas. El estudio incluyó 15 ratas macho blancas, sexualmente maduras que pesaban 276,75 ± 6,56 gramos. Se realizó una simulación de peritonitis séptica perforando la parte superior del ciego con cuatro punciones con una aguja de inyección G16. Como resultado del experimento, después del examen de la cavidad peritoneal, a los 15 animales se les diagnosticó taponamiento del omento o lesión perforada del ciego. En 11 casos, la pared perforada del ciego fue recubierta por el omento mayor (73,34 %), y en los otros 4 animales el taponamiento se realizó por uno de los epidídimos (26,66 %). La etapa inicial del taponamiento con omento mayor o epidídimo de un ciego perforado comienza el primer día del experimento y consiste en una estrecha consolidación intersticial entre ellos, así como en la invasión de los vasos sanguíneos desde el lado del omento hasta el foco de infección, que aseguran la entrega de las células inmunocompetentes apropiadas. Como resultado de este proceso, se forman intensos infiltrados linfoides en esta zona, así como el crecimiento de tejido adiposo, que aísla el foco inflamatorio de la cavidad peritoneal con una gruesa capa.


Assuntos
Animais , Masculino , Ratos , Peritonite/patologia , Omento/patologia , Linfócitos , Ceco/patologia , Adipócitos , Modelos Animais de Doenças , Duodeno/patologia
2.
Rev. colomb. cir ; 39(1): 94-99, 20240102. fig, tab
Artigo em Espanhol | LILACS | ID: biblio-1526827

RESUMO

Introducción. La gastrectomía y disección ganglionar es el estándar de manejo para los pacientes con cáncer gástrico. Factores como la identificación de ganglios por el patólogo, pueden tener un impacto negativo en la estadificación y el tratamiento. El objetivo de este estudio fue comparar el recuento ganglionar de un espécimen quirúrgico después de una gastrectomía completa (grupo A) y de un espécimen con un fraccionamiento por grupos ganglionares (grupo B). Métodos. Estudio de una base de datos retrospectiva de pacientes sometidos a gastrectomía D2 en el Servicio de Cirugía gastrointestinal de la Liga Contra el Cáncer seccional Risaralda, Pereira, Colombia. Se comparó el recuento ganglionar en especímenes quirúrgicos con y sin división ganglionar por regiones anatómicas previo a su envío a patología. Resultados. De los 94 pacientes intervenidos, 65 pertenecían al grupo A y 29 pacientes al grupo B. El promedio de ganglios fue de 24,4±8,6 y 32,4±14,4 respectivamente (p=0,004). El porcentaje de pacientes con más de 15 y de 25 ganglios fue menor en el grupo A que en el grupo B (27 vs 57, p=0,432 y 19 vs 24, p=0,014). El promedio de pacientes con una relación ganglionar menor 0,2 fue mayor en el grupo B (72,4 % vs 55,4 %, p=0,119). Conclusiones. Los resultados de nuestro estudio mostraron que una división por grupos ganglionares previo a la valoración del espécimen por el servicio de patología incrementa el recuento ganglionar y permite establecer de manera certera el pronóstico de los pacientes, teniendo un impacto positivo en su estadificación, para evitar el sobretratamiento


Introduction. A gastrectomy and lymph node dissection is the standard of management for patients with gastric cancer. Factors such as the identification of nodes by the pathologist can have a negative impact on staging and treatment. The objective of this study was to compare the lymph node count of a surgical specimen after a complete gastrectomy (group A) and of a specimen with lymph node by groups (group B). Methods. Study of a retrospective database of patients undergoing D2 gastrectomy in the Risaralda section of the Liga Contra el Cancer Gastrointestinal surgical service, Pereira, Colombia. The lymph node count was compared in surgical specimens with and without lymph node division by anatomical regions, prior to sending them to pathology. Results. Of the 94 patients who underwent surgery, 65 were from group A and 29 patients were from group B. The average number of nodes was 24.4±8.6 and 32.4±14.4, respectively (p=0.004). The percentage of patients with more than 15 and 25 nodes was lower in group A than in group B (27 vs 57, p=0.432 and 19 vs 24, p=0.014). The average number of patients with a nodal ratio less than 0.2 was higher in group B (72.4% vs 55.4%, p=0.119). Conclusions. The results of our study showed that a division by lymph node groups prior to the evaluation of the specimen by the pathology service increases the lymph node count and allows the prognosis of patients to be accurately established, having a positive impact on their staging, to avoid overtreatment.


Assuntos
Humanos , Neoplasias Gástricas , Excisão de Linfonodo , Estadiamento de Neoplasias , Gastrectomia , Linfonodos , Metástase Linfática
3.
Ginecol. obstet. Méx ; 92(4): 145-152, ene. 2024. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1557868

RESUMO

Resumen OBJETIVO: Describir las características sociodemográficas, clínicas y patológicas y los resultados obtenidos con la técnica de ganglio centinela con azul patente en la cirugía de cáncer de mama temprano. Además, reportar la experiencia en la identificación del ganglio centinela en cáncer de mama temprano con la técnica con azul patente al 2.5%. MATERIALES Y MÉTODOS: Estudio retrospectivo y analítico consistente en la evaluación de los expedientes clínicos de pacientes diagnosticadas con cáncer de mama temprano, sin sospecha clínica o radiológica de afectación axilar, atendidas entre junio de 2022 y junio de 2023 en el servicio de Ginecología Oncológica de la UMAE Hospital de Ginecoobstetricia, Centro Médico Nacional de Occidente del IMSS. El sitio de inyección del colorante fue subdérmico periareolar, los ganglios identificados se estudiaron en el transoperatorio. Se analizaron el porcentaje de identificación, las tasas de falsos negativos y el valor predictivo negativo del método. RESULTADOS: Se analizaron 95 procedimientos de biopsia de ganglio centinela. Solo se practicó la linfadenectomía axilar en las pacientes con metástasis en el ganglio centinela comprobada en el estudio transoperatorio y en las que no se identificaron ganglios teñidos por no migración del colorante. La edad promedio de las pacientes fue de 57.1 años límites 25 y 78 años. El tamaño del tumor fue menor a 3 cm. A 64 67% pacientes se les hizo la mastectomía en comparación con 31 a quienes se efectuó cirugía conservadora de mama 33%. Se estadificaron como IA 57 de las 95 pacientes; el subtipo molecular más frecuente fue compatible con luminal A en 49%. CONCLUSIONES: La biopsia del ganglio centinela, con azul patente, es una técnica rápida, sencilla, precisa y de bajo costo para identificar daño axilar en etapas tempranas del cáncer de mama. Lo aquí reportado son resultados que corresponden a una primera evaluación de la técnica en nuestro servicio.


Abstract OBJECTIVE: To describe the sociodemographic, clinical and pathological characteristics and results of the patent blue sentinel lymph node technique in early breast cancer surgery. And to report the experience in identifying the sentinel lymph node in early breast cancer using the 2.5% patent blue technique. MATERIALS AND METHODS: Retrospective and analytical study consisting of the evaluation of the clinical records of patients diagnosed with early breast cancer, without clinical or radiological suspicion of axillary involvement, seen between June 2022 and June 2023 at the Oncological Gynaecology Service of the UMAE Hospital de Ginecoobstetricia, Centro Médico Nacional de Occidente of the IMSS. The dye injection site was subdermal periareolar, and the identified lumps were examined in the transoperative period. The percentage of identification, false negative rates and negative predictive value of the method were analysed. RESULTS: Ninety-five sentinel node biopsies were analysed. Axillary lymphadenectomy was performed only in patients with sentinel lymph node metastasis confirmed at surgery and in those in whom no stained nodes were identified due to non-migration of the dye. The mean age of the patients was 57.1 years range 25 to 78 years. The tumour size was less than 3 cm. Sixty-four patients 67% underwent mastectomy, compared with 31 who underwent breast-conserving surgery 33%. Fifty-seven of the 95 patients were staged as AI; the most common molecular subtype was compatible with luminal A in 49%. CONCLUSIONS: Sentinel lymph node biopsy with patent blue is a rapid, simple, accurate and inexpensive technique for identifying axillary disease in early breast cancer. The results reported here represent an initial evaluation of the technique in our service.

4.
Rev. méd. Urug ; 40(2)2024.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1560257

RESUMO

Introducción: el cáncer de cuello (CC) uterino representa un problema de salud pública. En Uruguay ocupa el tercer lugar en incidencia en mujeres, provocando 133 fallecimientos anuales. La afectación ganglionar es uno de sus principales factores pronósticos y condiciona el tratamiento. El ganglio centinela (GC) en estadios precoces de cáncer cervicouterino es una técnica segura que permite una adecuada estadificación y reduce la morbilidad asociada a la linfadenectomía convencional. Objetivo: validar la utilización de la técnica de la biopsia GC en estadios precoces de CC como estándar de tratamiento para la detección de metástasis ganglionares en el Hospital de la Mujer. Material y método: se realizó un estudio prospectivo, longitudinal, de casos. Se incluyó a 30 usuarias con CC en estadios iniciales, en el período comprendido entre enero de 2018 y noviembre de 2022. La marcación se realizó con tecnecio 99m (99mTc). En el mismo acto quirúrgico se realizó la linfadenectomía pélvica sistemática. Resultados: se detectó GC de forma bilateral en 29 de 30 pacientes. Con una tasa de detección por región de 98,3%. En cinco pacientes se detectaron GC metastásicos, no encontrando ganglios no centinela positivos. Una de ellas correspondió a una micrometástasis detectada por ultraestadificación. La sensibilidad fue de 100%: IC95% (56,55 -100) con VPN 100% IC95% (86,68 - 100). Conclusiones: de acuerdo con los resultados arrojados por el estudio, el equipo interdisciplinario del Hospital de la Mujer está en condiciones de utilizar la biopsia de GC de cérvix como estándar de tratamiento en el CC uterino en estadio precoz.


Introduction: Cervical cancer (CC) is a public health problem. In Uruguay, it ranks third in incidence in women, causing 133 deaths annually. Lymph node involvement is one of its main prognostic factors and determines treatment. The sentinel lymph node (SLN) in early stages of cervical cancer is a safe technique that allows for adequate staging and reduces morbidity associated with conventional lymphadenectomy. Objective: To validate the use of the SLN biopsy technique in early stages of CC as the standard treatment for detecting lymph node metastases at the Women's Hospital. Method: A prospective, longitudinal case study was conducted. Thirty patients with early-stage cervical cancer between January 2018 and November 2022 were included in the study. The marking was done with Tc99. Systematic pelvic lymphadenectomy was performed in the same surgical procedure. Results: Sentinel lymph nodes were detected bilaterally in 29 out of 30 patients. With a detection rate per region of 98.3%, metastatic SLNs were detected in 5 patients, with no positive non-sentinel nodes found. One of them corresponded to a micrometastasis detected by ultra-staging. Sensitivity was 100% (95% CI 56.55,100) with a negative predictive value of 100% (95% CI 86.68, 100). Conclusions: According to the results of the study, the interdisciplinary team at the Women's Hospital is in a position to use cervical SLN biopsy as the standard treatment for early-stage cervical cancer.


Introdução: O câncer do colo do útero (CCU) representa um problema de saúde pública. No Uruguai, ocupa o terceiro lugar em incidência em mulheres, causando 133 mortes por ano. O acometimento dos linfonodos é um dos principais fatores prognósticos e condiciona o tratamento. O linfonodo sentinela (LS) em estágios iniciais do câncer do colo do útero é uma técnica segura que permite o estadiamento adequado e reduz a morbidade associada à linfadenectomia convencional. Objetivo: Validar o uso da técnica de biópsia por LS em estágios iniciais do CCU como tratamento padrão para a detecção de metástases linfonodais no Hospital da Mulher. Materiais e métodos: Foi realizado um estudo de caso prospectivo e longitudinal. Trinta usuárias com LS em estágio inicial foram incluídas no período de janeiro de 2018 a novembro de 2022. A marcação foi realizada com Tc99. A linfadenectomia pélvica sistemática foi realizada no mesmo ato cirúrgico. Resultados: O LS foi detectado bilateralmente em 29 das 30 usuárias, com uma taxa de detecção por região de 98,3%. Em 5 pacientes foram detectados LS metastáticos e não foram encontrados nódulos não-sentinela positivos. 1 deles correspondia a uma micrometástase detectada por ultrassonografia. A sensibilidade foi de 100% CI 95% (56,55,100) com NPV 100% CI 95% (86,68, 100). Conclusões: Com base nos resultados do estudo, a equipe interdisciplinar do Hospital da Mulher está em condições de usar a biópsia de LS cervical como padrão de tratamento no câncer cervical em estágio inicial.

5.
Artigo em Chinês | WPRIM | ID: wpr-1006513

RESUMO

@#Objective    To predict the probability of lymph node metastasis after thoracoscopic surgery in patients with lung adenocarcinoma based on nomogram. Methods    We analyzed the clinical data of the patients with lung adenocarcinoma treated in the department of thoracic surgery of our hospital from June 2018 to May 2021. The patients were randomly divided into a training group and a validation group. The variables that may affect the lymph node metastasis of lung adenocarcinoma were screened out by univariate logistic regression, and then the clinical prediction model was constructed by multivariate logistic regression. The nomogram was used to show the model visually, the receiver operating characteristic (ROC) curve, calibration curve and clinical decision curve to evaluate the calibration degree and practicability of the model. Results    Finally 249 patients were collected, including 117 males aged 53.15±13.95 years and 132 females aged 47.36±13.10 years. There were 180 patients in the training group, and 69 patients in the validation group. There was a significant correlation between the 6 clinicopathological characteristics and lymph node metastasis of lung adenocarcinoma in the univariate logistic regression. The area under the ROC curve in the training group was 0.863, suggesting the ability to distinguish lymph node metastasis, which was confirmed in the validation group (area under the ROC curve was 0.847). The nomogram and clinical decision curve also performed well in the follow-up analysis, which proved its potential clinical value. Conclusion    This study provides a nomogram combined with clinicopathological characteristics, which can be used to predict the risk of lymph node metastasis in patients with lung adenocarcinoma with a diameter≤3 cm.

6.
Medisur ; 21(6)dic. 2023.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1550559

RESUMO

La enfermedad de Kawasaki es un síndrome mucocutáneo caracterizado por vasculitis, que afecta medianos vasos; su principal manifestación es un síndrome febril agudo de, al menos, cinco días de duración y en muchas ocasiones de etiología desconocida. Se aprecia, fundamentalmente, en niños menores de cinco años de edad. Se considera que es frecuente, pero existen subregistros. Se caracteriza por tener dos formas de presentación: típica o atípica. Se presenta el caso clínico de un niño que fue hospitalizado debido a síndrome febril agudo asociado a malestar general e irritabilidad. Al examen físico se observaron edemas discretos en manos y pies así como erupción cutánea, no hepatomegalia ni alteraciones oculares. Teniendo en cuenta la epidemiología, lo atípico del cuadro clínico y los resultados de estudios hemoquímicos, se concluyó el diagnóstico de enfermedad de Kawasaki atípica. Se impuso tratamiento específico y se logró una evolución satisfactoria y la no aparición de complicaciones inmediatas. Esta entidad nosológica requiere de una adecuada valoración clínica-epidemiológica de los pacientes, así como de un minucioso examen físico y un diagnóstico precoz para lograr la evolución favorable de los pacientes y la no presencia de secuelas cardiacas, que pondrían en peligro la vida del paciente y/o su calidad de vida futura.


Kawasaki disease (KD) is a mucocutaneous syndrome characterized by vasculitis that affects medium vessels; its main manifestation is an acute febrile syndrome lasting at least five days and often of unknown etiology. It appears mainly in children under five years of age, it is considered to be frequent, but there are underreportings. It is characterized by having two presentation forms: typical or atypical. The clinical case of a child who was hospitalized due to acute febrile syndrome associated with malaise and irritability is presented. The physical examination revealed discrete edema in the hands and feet as well as a rash, no hepatomegaly or ocular alterations. Taking into account the epidemiology, the atypical clinical picture and the results of hemochemical studies, the diagnosis of atypical Kawasaki disease was concluded. Specific treatment was imposed and a satisfactory evolution was achieved with no immediate complications. This nosological entity requires an adequate clinical-epidemiological evaluation of the patients, as well as a meticulous physical examination and an early diagnosis to achieve a favorable patients' evolution and the absence of cardiac sequelae, which would endanger the patients' life and/or their future quality of life.

7.
Medicina (B.Aires) ; 83(3): 376-383, ago. 2023. graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1506691

RESUMO

Abstract Introduction : Immediate completion lymph node dissection (CLND) performed in patients with a positive sentinel lymph node biopsy (SLNB) cutaneous melanoma is not associated with improved melanoma specific survival versus active surveillance (AS) using nodal ul trasound. Clinical practice experience and outcomes of AS and adjuvant therapy is now starting to be published in literature. Methods : Retrospective analysis of patients with a positive-SLNB between June/2017-February/2022. Impact of management on any-site recurrence free survival (RFS), isolated nodal recurrence (INR), distant metasta sis-free survival (DMFS) and melanoma-specific survival (MSS) was evaluated. Results : From 126 SLNB, 31 (24.6%) were positive: 24 received AS and 7 CLND. Twenty-one (68%) received ad juvant therapy (AS, 67% and CLND, 71%). With a median follow-up of 18 months, 10 patients developed recur rent disease with an estimated 2-yr RFS of 73% (CI95%, 0.55-0.86) (30% in AS group vs. 43% in dissection group; P = 0.65). Four died of melanoma with an estimated 2-yr MSS of 82% (CI 95%, 0.63-0.92) and no differences between AS and CLND groups (P = 0.21). Estimated 2-yr DMFS of the whole cohort was 76% (CI 95%, 0.57-0.88) with no differences between groups (P = 0.33). Conclusion : Active surveillance strategy has been adopted for most positive-SLNB cutaneous melanoma patients. Adjuvant therapy without immediate CLND was delivered in nearly 70% of patients. Our results align with outcomes of randomized control trials and previous real-world data.


Resumen Introducción : La linfadenectomía inmediata (LI) re alizada en pacientes con biopsia de ganglio centinela (BGC) positivo por melanoma cutáneo no está asociada a mejoría en la supervivencia libre de enfermedad vs. vigilancia activa (VA). Resultados oncológicos y experi encia en la práctica clínica con dicha conducta asociados a tratamiento adyuvante comienzan a ser publicados en la literatura. Métodos : Análisis retrospectivo incluyendo paci entes con BGC-positiva por melanoma cutáneo entre junio/2017-febrero/2022. Se evaluó impacto del manejo en: supervivencia libre de recurrencia (SLR), recurren cia ganglionar aislada (RGA), supervivencia libre de metástasis a distancia (SLMD) y supervivencia libre de enfermedad (SLE). Resultados : De 126 pacientes, 31 (24.6%) fueron positi vos: en 24 se realizó VA y en 7 LI. Veintiún pacientes (68%) recibieron tratamiento adyuvante (VA, 67% y LI, 71%). Con una media de seguimiento de 18 meses, 10 pacientes presentaron recurrencia de la enfermedad con una SLR estimada a 2 años del 73% (CI95%, 0.55-0.86) (30% en VA vs. 43% en LI; P = 0.65). Cuatro murieron de melanoma con una SLE a 2 años del 82% (CI 95%, 0.63-0.92); sin diferencia entre ambos grupos (P = 0.21). La SLMD a 2 años de toda la cohorte fue de 76% (CI 95%, 0.57-0.88; P = 0.33). Conclusión : La vigilancia activa se ha adoptado como conducta para la mayoría de los pacientes con BGC-positivo. El tratamiento adyuvante sin linfadenectomía inmediata se realizó en cerca del 70% de nuestra serie. Los resultados de nuestra serie son similares a los re portados en la literatura.

8.
Rev. argent. cir ; 115(3): 223-232, ago. 2023. graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1514929

RESUMO

RESUMEN Antecedentes: la evaluación precisa del estadio del carcinoma pulmonar luego del diagnóstico es esencial para la selección de una terapia apropiada. Objetivo: describir las características de los pacientes con carcinoma de pulmón de células no pequeñas en los cuales la resección ganglionar supraclavicular permitiría detectar metástasis ganglionares no palpables (N3-supraclavicular). Material y métodos: entre diciembre de 2016 y diciembre de 2019 se registraron los datos de pacientes a quienes se les realizó estadificación quirúrgica mediastinal para cáncer de pulmón de células no pequeñas mediante mediastinoscopia cervical y resección de los ganglios supraclaviculares. Resultados: fueron incluidos 60 pacientes, (hombres 76,7%). La media tumoral fue de 4,7 cm y la de estaciones ganglionares evaluadas fue de 2,37 ± 1,44 (DS). En todos se realizó la resección ganglionar supraclavicular y el resultado fue positivo para malignidad epitelial en 21 casos (35%). De los 21 casos N3-supraclavicular, 2 pacientes se registraron como skip metástasis; el resto se asoció a enfermedad mediastinal N2 (p=0,0424). Se observó una asociación significativa entre le presencia de tumor central y de N3-supraclavicular (p=0,0148). Conclusión: se sugiere realizar la resección ganglionar supraclavicular en pacientes con sospecha o confirmación de enfermedad ganglionar N2 y tumores centrales, antes de considerar un enfoque terapéutico multimodal que incluya la cirugía.


ABSTRACT Background: Accurate staging after the diagnosis of lung carcinoma is essential to select an appropriate therapy. Objective: The aim of the present study is to describe the characteristics of patients with non-small cell lung carcinoma in whom supraclavicular lymph node resection would detect non-palpable (N3 supraclavicular disease) lymph node metastases. Material and methods: Data from patients undergoing mediastinal surgical staging for non-small cell lung cancer using cervical mediastinoscopy and resection of supraclavicular lymph nodes were collected between December 2016 and December 2019. Results: A total of 60 patients were included; 76.6% were men. Mean tumor size was 4.7 cm ad mean lymph node stations evaluated by mediastinoscopy was 2.37 ± 1.44 (SD). All the patients underwent supraclavicular lymph node resection and the result was positive for epithelial carcinoma in 21 cases (35%). Of the 21 cases with N3 supraclavicular disease, 2 patients were recorded as skip metastases and the remaining cases were association with mediastinal N2 disease (p = 0.0424). There was a significant association between central tumor and N3 supraclavicular disease (p = 0.0148). Conclusion: Supraclavicular lymph node resection may be recommended in patients with suspected or confirmed N2 lymph node disease and central tumors, before considering a multimodal therapeutic approach including surgery.

9.
Rev. cir. (Impr.) ; 75(4)ago. 2023.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1515241

RESUMO

Introducción: La biopsia ganglionar retroperitoneal es un procedimiento frecuentemente requerido en el estudio de neoplasias; resulta deseable optimizar su rendimiento con baja morbilidad. Este artículo describe la utilidad y complicaciones de biopsias ganglionares retroperitoneales por laparoscopia en una institución oncológica de Latinoamérica. Material y Métodos: Cohorte retrospectiva de pacientes con biopsia ganglionar retroperitoneal o mesentérica laparoscópica entre 2011 y 2021 en el Instituto Nacional de Cancerología, en Bogotá, Colombia. Se recogieron datos demográficos, quirúrgicos, complicaciones y mortalidad a 30 días, resultados histopatológicos y su rol en la clínica. Resultados: Se incluyeron 41 pacientes; 73% con diagnóstico de malignidad, principalmente linfoma. La indicación fue mayormente sospecha de recaída, seguida por sospecha de enfermedad hematológica de novo. Siempre se obtuvo tejido adecuado y suficiente para diagnóstico histológico. Requirieron conversión a laparotomía cinco pacientes (12%). No hubo complicaciones Clavien-Dindo III /IV ni mortalidad a 30 días. Se presentó morbilidad grado I o II en 3 casos (7%) y un incidente intraoperatorio grado III. Conclusión: La naturaleza invasiva y el carácter diagnóstico de la biopsia retroperitoneal laparoscópica, constituyen un desafío frecuente en la práctica del cirujano general. La planeación estratégica e individualizada y la técnica quirúrgica depurada son las claves para lograr el máximo rendimiento, con baja morbimortalidad.


Introduction: Retroperitoneal lymph node biopsy is a frequently required procedure in the study of neoplasms; it is desirable to optimize its performance with low morbidity. This paper describes the usefulness and complications of retroperitoneal lymph node biopsies by laparoscopy in a cancer institution in Latin America. Material and Methods: Retrospective cohort of patients with laparoscopic retroperitoneal or mesenteric lymph node biopsy between 2011 and 2021 at the National Cancer Institute, in Bogotá, Colombia. Demographic and surgical data, complications and 30-day mortality, histopathological results and their clinical role were collected. Results: 41 patients were included; 73% diagnosed with malignancy, mainly lymphoma. The indication was mostly suspected relapse, followed by suspected de novo hematologic disease. Adequate and sufficient tissue was always obtained for histological diagnosis. Five patients (12%) required conversion to laparotomy. There were no Clavien-Dindo III/IV complications or 30-day mortality. Grade I or II morbidity occurred in 3 cases (7%) and a grade III intraoperative incident. Conclusion: The invasive nature and diagnostic character of laparoscopic retroperitoneal biopsy constitute a frequent challenge in the practice of the general surgeon. Strategic and individualized planning and a refined surgical technique are the keys to achieving maximum performance, with low morbidity and mortality.

10.
Rev. cir. (Impr.) ; 75(4)ago. 2023.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1515242

RESUMO

Objetivo: El carcinoma sebáceo (CS) es una neoplasia infrecuente, de la cual no existen reportes nacionales, ni guías de manejo en Chile. El Instituto Nacional del Cáncer (INC) es un centro de referencia nacional en el manejo de patologías oncológicas; el objetivo de este trabajo es describir la experiencia y tratamiento del carcinoma sebáceo en nuestro centro. Material y Método: Se realizó una revisión retrospectiva, descriptiva, de fichas clínicas entre marzo de 2016 y marzo de 2022 en el INC, en las cuales la biopsia definitiva fuese confirmatoria de CS. Resultados: Se reclutaron 10 pacientes, 6 hombres (60%) y 4 mujeres. Edad promedio fue de 62,9 años ± 18,7 DS. En el 80% de los casos el tumor se encontró en cabeza y cuello y solo 2 casos fueron CS ocular (20%). 4 pacientes tenían asociación al Síndrome de Muir-Torre (SMT) (40%), en el 100% de la muestra se realizó tratamiento quirúrgico con resección oncológica y control de márgenes intraoperatorio, utilizándose en solo 3 casos la técnica Cirugía Micrográfica de Mohs (MMS). En 4 pacientes (40%) se realizó biopsia de linfonodo centinela (BLNC), de los cuales ninguno resulto positivo para metástasis. Ningún paciente presento recidiva local, después de la cirugía y no hubo casos de mortalidad a causa de CS. Ningún paciente recibió radioterapia, quimioterapia o inmunoterapia adyuvante, solo 1 paciente recibió braquiterapia (BT) adyuvante. Conclusión: El CS es una patología compleja e infrecuente, que requiere un tratamiento multidisciplinario y cuyo pilar es la cirugía.


Objective: Sebaceous carcinoma (SC) is an infrequent neoplasm, without national reports nor management guidelines in Chile. National Cancer Institute (NCI) is a reference center for this kind of disease. The aim of this research is to describe the experience and treatment of the sebaceous carcinoma in our center. Methods: A retrospective, descriptive review of clinical records was performed, between March 2016 and March 2022 at the INC, in which the definitive biopsy was confirmatory of CS. Results: A total of 10 patients were enrolled; 6 male (60%) and 4 women. The mean age was 62.9 years ± 18.7 (SD). 80% of the cases were located at the head or the cervical area and only 2 cases were found in the ocular region (20%). Association with SMT (40%) was found in 4 patients. Surgical treatment with oncological resection and intraoperative assessment of margins was performed in 100% of the cases, using MMS technique. Sentinel lymph node biopsy (BLNC) was performed in 4 patients (40%), of which none had metastasis. No patient presented local recurrence after surgery and there were no cases of mortality due to CS. No patient received radiotherapy, chemotherapy or adjuvant immunotherapy. Just 1 received adjuvant brachytherapy. Conclusion: SC is a complex and infrequent disease, which requires multidisciplinary treatment mainly with surgery.

11.
Rev. chil. obstet. ginecol. (En línea) ; 88(4): 223-227, ago. 2023. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1515213

RESUMO

Objetivo: Validar la técnica de ganglio centinela utilizando verde de indocianina en la estadificación del cáncer de endometrio. Método: Realizamos un estudio prospectivo entre enero y diciembre de 2021. Se incluyeron todas las pacientes portadoras de cáncer de endometrio clínicamente en etapa 1, de todos los grados de diferenciación e histologías. Todas las pacientes fueron sometidas a una estadificación laparoscópica. Se inició el procedimiento con identificación de ganglio centinela utilizando verde de indocianina. Posteriormente, se completó la cirugía de estadiaje estándar en todas las pacientes. Los ganglios centinelas fueron procesados con técnica de ultraestadiaje. Resultados: Se incluyeron 33 pacientes. El 81% presentaron histología endometrioide. El 100% fueron sometida además a una linfadenectomía pelviana estándar y el 20% a una linfadenectomía paraaórtica simultáneamente. Se detectó al menos un ganglio centinela en el 100% de los casos. La detección bilateral ocurrió en el 90,9%. La localización más frecuente fue la fosa obturatriz y la arteria hipogástrica. Obtuvimos una sensibilidad del 90% para detectar enfermedad ganglionar y un valor predictivo negativo del 95,8%. Conclusiones: La técnica de ganglio centinela utilizando verde de indocianina es replicable. Los resultados de nuestra serie nos permiten realizar procedimientos menos agresivos al estadificar el cáncer de endometrio.


Objective: To validate sentinel node mapping using indocyanine green in endometrial cancer staging. Method: A prospective study was conducted between January and December 2021. All patients with clinically stage 1 endometrial cancer, of all grades and histologies were included. All patients underwent laparoscopic staging. The procedure began with identification of the sentinel node using indocyanine green. Subsequently, standard staging surgery was completed in all patients. Sentinel nodes were processed using ultrastaging technique. Results: Thirty-three patients were enrolled. 81% of cases had endometrioid histology. All patients also underwent a standard pelvic lymphadenectomy and in 20% of cases a para-aortic lymphadenectomy. At least one sentinel node was detected in 100% of the cases. Bilateral detection occurred in 90.9%. The most frequent location was obturator fossa and hypogastric artery. Sensitivity to detect lymph node disease was 90% and negative predictive value 95.8%. Conclusions: Sentinel lymph node mapping using indocyanine green is a replicable technique. Our results allows us to perform less aggressive procedures in endometrial cancer staging.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/patologia , Biópsia de Linfonodo Sentinela/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Neoplasias do Endométrio/cirurgia , Verde de Indocianina , Excisão de Linfonodo , Estadiamento de Neoplasias/métodos
12.
Artigo | IMSEAR | ID: sea-222339

RESUMO

Oral signs are an early indicator for a variety of systemic diseases. Gingival enlargement can be due to local factors, certain medications, hormonal changes, and malignant diseases. Leukemia is a malignancy characterized by the proliferation of abnormal white blood cells within the bone marrow; oral changes may be the first and only presenting feature in these patients, making it imperative for dental surgeons to make accurate diagnosis and timely referral to prevent a fatal situation. This article aims to discuss a case of acute myeloid leukemia (AML) that came with the chief complaint of swollen gums for 2-month duration. The case was provisionally diagnosed as a leukemic gingival enlargement on the basis of oral manifestation and lymph node examination. Accurate diagnosis and early initiation of chemotherapy for leukemic gingival enlargement can improve the prognosis of the patient and also helps in avoiding complications. Around 50–80% of patients with AML achieve complete remission, more often in children and patients under the age of 60. This paper aims at emphasizing the importance of thorough oral examination and careful investigations to identify the underlying life-threatening condition.

13.
Indian J Cancer ; 2023 Jun; 60(2): 237-241
Artigo | IMSEAR | ID: sea-221783

RESUMO

Background: Axillary lymph node status is one of the most important prognostic factors for breast cancer. Sentinel lymph node biopsy (SLNB) after mastectomy is highly controversial. There is not enough data about SLNB in the early period after nipple?sparing mastectomy (NSM). This study investigated the feasibility of SLNB in the early postoperative period of NSM. Materials and Methods: Patients who were operated on for breast cancer in Acibadem Maslak Hospital between 2009 and 2018 were searched retrospectively. Results of SLNB as the second session in patients whose final pathology report revealed breast carcinoma after contralateral/bilateral prophylactic mastectomy and mastectomy for benign lesions were evaluated. Results: In the early period (median 14 days) after NSM, SLNB was performed by intradermal radioisotope injection in five patients with occult breast cancer in contralateral/bilateral prophylactic mastectomy and in one patient with preoperatively suspicious mass which yielded breast cancer at final pathology. In five (80%) patients, SLNB was performed, whereas in one patient axillary lymph node dissection (ALND) was performed due to the undetectability of SLN. In one patient, micrometastasis was observed, whereas no metastasis was observed in other patients including the one who underwent ALND. No complication due to SLNB was detected. No recurrence and distant metastasis were detected in a mean follow?up of 42.82 (19�) months. While SLNB did not change the treatment of patients with contralateral occult carcinoma, other patients had hormonal therapy due to negative SLNB. Conclusion: SLNB in the early postoperative period of NSM can be performed by intradermal radioisotope injection. However, further studies are needed to determine the feasibility of SLNB in the early postoperative period of NSM

14.
Artigo | IMSEAR | ID: sea-222315

RESUMO

Neck lymph node metastasis is the most critical factor influencing the survival and prognosis of oral squamous cell carcinoma. The outcome of patients with lymph node metastases occurring after excision or radiotherapy of the primary tumor is poor. In the absence of ipsilateral nodal metastases, contralateral lymph neck metastasis is extremely rare. Reports of skip metastases have been recorded for lesions of the tongue and floor of the mouth as there is free communication between the two sides of the tongue. Intraoperative frozen sections of neck nodes have been used as a modality for the detection of occult metastases and to guide the extent of neck dissection but have not provided satisfactory results. The case described in this report is a rare phenomenon that demonstrates a well-lateralized clinically advanced buccal mucosa carcinoma with histologically proven node-negative neck but exhibited contralateral positive neck after a span of 1 month.

15.
Artigo | IMSEAR | ID: sea-218866

RESUMO

Introduction: Fine needle aspiration cytology (FNAC) is a widely accepted first line of investigation to diagnose the cause of lymphadenopathy. A standardized categorization and reporting system for lymph node cytology was proposed in 20th International Congress of Cytology at Sydney which consisted of 5 categories (L1, L2, L3, L4, L5) with management recommendations for each. Aims and Objective: To review the application of the Sydney system in achieving a uniform standardized approach for classifying and reporting lymph node cytology and to assess the risk of malignancy (ROM) for each category. : A 2 year single institute retrospective study. Clinical details were collectedMaterials and Methods from the patient records and cytology smears were reviewed by 2 cyto-pathologists as per the Sydney system. Histological correlation was done wherever possible. Statistical analysis was performed. 437 cases were re-Results: evaluated, with mean age of 39.66 years, slight male preponderance and cervical lymph node being the most common site. L2/Benign was the most common category with reactive lymphoid hyperplasia being the most common diagnosis and metastatic squamous cell carcinoma was the most common L5/malignant diagnosis. Histopathological correlation was available for 40 (9.1%) cases and the highest calculated risk of malignancy (ROM) was for L4 and L5 categories (100% each). The diagnostic accuracy of the proposed Sydney system in our study was 96.66%. TheConclusion: proposed Sydney system improves the diagnostic accuracy and standardizes the reporting of lymph node cyto- pathology. It improves the patient care by giving management recommendation to the clinicians.

16.
Univ. salud ; 25(1): D6-D14, ene.-abr. 2023. tab, ilus
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1424737

RESUMO

Introduction: Lymph node involvement is the main prognostic factor in breast cancer. Mastectomized patients usually undergo lymphadenectomy (LA) of micrometastatic sentinel lymph nodes (SLNs) despite the evidence of AMAROS trial to replace this therapy with radiotherapy in select cases. Objective: Demonstrate the ability of ultrasonography to detect non-metastatic or micrometastatic SLNs. Materials and methods: 132 patients who underwent mastectomy were evaluated. Ultrasound-guided fine-needle aspiration biopsy (FNAB) was indicated for suspicious lymph nodes. LA and SNL biopsy (SLNB) were performed in patients with positive and negative FNAB, respectively. LA was performed in FNAB positive or SLNB positive cases, except in the presence of isolated tumor cells and micrometastatic SLNs. The tumor burden after LA in patients with negative FNAB and positive SLNB was measured; the presence of two or fewer positive SLNs was considered a low burden. Results: Sensitivity of FNAB for detecting positive lymph nodes in patients with a high tumor burden was 93% and specificity was 84%. Positive (PPV) and negative predictive value (NPV) were 60% and 79%, respectively. Conclusions: LA could have been avoided in 90% of mastectomized patients with negative FNAB and a low tumor burden who met the AMAROS criteria with a high NPV (79%).


Introducción: La afectación ganglionar es el principal factor pronóstico en cáncer de seno. Generalmente, pacientes mastectomizadas se somenten a linfadenectomia (LA) de ganglios linfáticos centinela micrometastásicos (GLCs), a pesar de la evidencia del ensayo AMAROS en ciertos casos para reemplazarla con radioterapia. Objetivo: Demostrar la importancia de la ecografía para detectar GLCs no metastásicos o micrometastásicos. Materiales y métodos: Se evaluaron132 pacientes sometidas a mastectomía. Se recomendó biopsia aspirativa con aguja fina (BAAF) por ultrasonido para ganglios linfáticos sospechosos. Se realizó Biopsia LA y biopsia de GLCs (BGLC) en pacientes con BAAF positiva y negativa, respectivamente. En casos positivos de BAAF o BGLC se ejecutó LA, excepto en presencia de células tumorales aisladas y GLCs. Se evaluó la carga tumoral posterior a LA en pacientes con BAAF negativa y BGLC positiva. La presencia de dos o menos GLC positivos se consideró carga baja. Resultados: La sensibilidad de BAAF para detectar nódulos linfáticos positivos en pacientes con alta carga tumoral fue del 93%; la especificidad fue del 79%. Valores predictivos positivo (60%) y negativo (79%). Conclusiones: Se podría haber evitado LA en 90% de pacientes mastectomizadas con BAAF negativa y baja carga tumoral que cumplían criterios AMAROS con alto VPN (79%).


Introdução: O comprometimento dos gânglios é o principal fator prognóstico no câncer de mama. Geralmente, pacientes mastectomizadas são submetidas a linfadenectomia (LA) de gânglios linfáticos sentinelas de micrometástases (GLSs), apesar da evidência do estudo AMAROS em certos casos para substituí-la por radioterapia. Objetivo: Demonstrar a importância da ultrassonografia na detecção de GLSs não metastáticos ou micrometástase. Materiais e métodos: Foram avaliadas 132 pacientes submetidas à mastectomia. A biópsia aspirativa com agulha fina (BAAF) ultrassônica foi recomendada para gânglios linfáticos suspeitos. A biópsia LA e a biópsia do GLSs (BGLS) foram realizadas em pacientes com BAAF positivo e negativo, respectivamente. Nos casos positivos de BAAF ou BGLS, a LA foi realizada, exceto na presença de células tumorais isoladas e GLSs. A carga tumoral após a LA foi avaliada em pacientes com BAAF negativa e BGLS positiva. A presença de dois ou menos GLS positivos foi considerada carga baixa. Resultados: A sensibilidade do BAAF para detectar linfonodos positivos em pacientes com alta carga tumoral foi de 93%; a especificidade foi de 79%. Valores preditivos positivos (60%) e negativos (79%). Conclusões: a LA poderia ter sido evitada em 90% das pacientes mastectomizadas com BAAF negativa e baixa carga tumoral que preencheram os critérios AMAROS com alto VPN (79%).


Assuntos
Humanos , Feminino , Doenças Linfáticas , Neoplasias da Mama , Linfedema , Neoplasias
17.
Arch. endocrinol. metab. (Online) ; 67(4): e000607, Mar.-Apr. 2023. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1439229

RESUMO

ABSTRACT Objective: The purpose of these guidelines is to provide specific recommendations for the surgical treatment of neck metastases in patients with papillary, follicular, and medullary thyroid carcinomas. Materials and methods: Recommendations were developed based on research of scientific articles (preferentially meta-analyses) and guidelines issued by international medical specialty societies. The American College of Physicians' Guideline Grading System was used to determine the levels of evidence and grades of recommendations. The following questions were answered: A) Is elective neck dissection indicated in the treatment of papillary, follicular, and medullary thyroid carcinoma? B) When should central, lateral, and modified radical neck dissection be performed? C) Could molecular tests guide the extent of the neck dissection? Results/conclusion: Recommendation 1: Elective central neck dissection is not indicated in patients with cN0 well-differentiated thyroid carcinoma or in those with noninvasive T1 and T2 tumors but may be considered in T3-T4 tumors or in the presence of metastases in the lateral neck compartments. Recommendation 2: Elective central neck dissection is recommended in medullary thyroid carcinoma. Recommendation 3: Selective neck dissection of levels II-V should be indicated to treat neck metastases in papillary thyroid cancer, an approach that decreases the risk of recurrence and mortality. Recommendation 4: Compartmental neck dissection is indicated in the treatment of lymph node recurrence after elective or therapeutic neck dissection; "berry node picking" is not recommended. Recommendation 5: There are currently no recommendations regarding the use of molecular tests in guiding the extent of neck dissection in thyroid cancer.

18.
Clinics ; 78: 100216, 2023. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1447985

RESUMO

Abstract Background The presence of Extracapsular Extension (ECE) in the Sentinel Lymph Node Biopsy (SLNB) is still a doubt in the literature. Some studies suggest that the presence of ECE may be related to a greater number of positive axillary lymph nodes which could impact Disease Free Survival (DFS) and Overall Survival (OS). This study searches for the clinical significance of the ECE. Methods Retrospective cohort comparing the presence or absence of ECE in T1-2 invasive breast cancer with positive SLNB. All cases treated surgically at the Cancer Institute of the State of São Paulo (ICESP) between 2009 and 2013 were analyzed. All patients with axillary disease in SLNB underwent AD. Outcomes Identify the association between the presence and length of ECE and additional axillary positive lymph nodes, OS and DFS between both groups. Results 128 patients with positive SLNB were included, and 65 had ECE. The mean metastasis size of 0.62 (SD = 0.59) mm at SLNB was related to the presence of ECE (p < 0.008). The presence of ECE was related to a higher mean of positive sentinel lymph nodes, 3.9 (± 4.8) vs. 2.0 (± 2.1), p = 0.001. The median length of follow-up was 115 months. The OS and DFS rates had no differences between the groups. Conclusion The presence of ECE was associated with additional positive axillary lymph nodes in this study. Therefore, the OS and DFS were similar in both groups after 10 years of follow-up. It is necessary for additional studies to define the importance of AD when SLNB with ECE.

19.
Rev. Col. Bras. Cir ; 50: e20233521, 2023. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1449189

RESUMO

ABSTRACT Introduction: cutaneous melanoma (MC) is a malignant neoplasm derived from melanocytic cells with an aggressive behavior. It is usually associated with the multifactorial interaction of genetic susceptibility and environmental exposure, usually ultraviolet radiation. Despite advances in treatment, the disease remains relentless with poor prognosis. Sentinel lymph node (SLN) biopsy is a technique used to screen patients in need of lymph node dissection. Objectives: to correlate the tumor burden in the SLN with the mortality of patients undergoing SLN biopsy. Methodology: the medical records and histological slides of patients with MC who underwent SLN biopsy treated at HC-Unicamp from 2001 to 2021 were retrospectively analyzed. The positive SLN were measured according to the size of the tumor infiltration area, for analysis of the depth of invasion (DI), closest proximity to the capsule (CPC) and tumor burden (TB). For statistical analysis, associations between variables were analyzed using Fishers exact test, with post Bonferroni test and Wilcoxon test. Results: 105 records of patients who underwent SLN biopsy of MC were identified. Of these, nine (8.6%) had positive SLN and 81 (77.1%) had negative SLN. The performed lymphadenectomies resulted in 55.6% (n=5) affected, 22.2% (n=2) without disease and 22.2% (n=2) were not performed. Mean CPC, TB, and DI were 0.14mm, 32.10mm and 2.33mm, respectively. Patients with T2 and T3 tumors were more likely to show the SLN affected (p=0.022). No patient with positive SLN died during follow-up. Conclusion: patients who presented T3 staging are the ones who most presented positive SLN.


RESUMO Introdução: o melanoma cutâneo (MC) é uma neoplasia maligna de comportamento agressivo, derivada das células melanocíticas, geralmente causado pela associação de interação da suscetibilidade genética e a exposição ambiental. A biópsia do linfonodo sentinela (LNS) é um procedimento utilizado para rastreamento de doentes com necessidade ou não de linfadenectomia, diminuindo a exposição do paciente a cirurgias maiores. Objetivos: correlacionar a carga do tumor no LNS com a mortalidade de pacientes com MC. Métodos: foram examinados retrospectivamente prontuários e lâminas histológicas de doentes com MC submetidos a biópsia de LNS atendidos no HC-Unicamp entre o período compreendido de 2001 a 2021. Os LNS positivos foram mensurados quanto ao tamanho da área de infiltração do tumor, para análise da profundidade de invasão (PI), menor proximidade com a cápsula (MPC) e carga do tumor (CT). As associações entre as variáveis foram analisadas pelo teste Exato de Fisher, com pós teste de Bonferroni e Wilcoxon. Resultados: foram identificados 105 pacientes com biópsia de LNS, sendo nove (8,6%) casos com LNS positivo. A média de MDC, CT e PI foram 0,14 mm, 32,10 mm, e 2,33 mm, respectivamente. Doentes com tumores T2 e T3 apresentaram maior chance de acometimento do LNS (p=0,022). Nenhum paciente com LNS positivo foi a óbito durante o acompanhamento. Conclusão: doentes que apresentaram tumores maiores (T2 e T3) apresentaram maior chance de linfonodos sentinelas positivos. Além do tamanho do tumor, a presença de maior carga do tumor demonstrou que os mesmos podem ser beneficiados pela biópsia de LNS.

20.
Rev. Soc. Bras. Med. Trop ; 56: e0072, 2023. graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1449336

RESUMO

ABSTRACT Extrapulmonary tuberculosis associated with immune thrombocytopenia (ITP) is extremely rare. A likely association between ITP and pulmonary and lymph node tuberculosis was reported in a 29-year-old male patient. His platelet count decreased to 4,000/µL. Chest tomography revealed mediastinal adenomegaly, lymph node clusters in the aorta, and consolidation in the left upper lung lobe. Immunoglobulin and methylprednisolone were administered intravenously. The histopathology of the left upper lung lobe confirmed tuberculosis. The rifampicin/isoniazid/pyrazinamide/ethambutol regimen was initiated, and the corticosteroids were tapered off. This case suggests an association of tuberculosis with ITP, since the platelet count effectively normalized after tuberculosis treatment.

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