Community-acquired pneumonia associated with immunosuppression due to follicular thyroid cancer: a case report.

BACKGROUND: We present the case of a woman with cancer, which weakened the immune system and increased the risk of infection. Thus, infections are a frequent complication of cancer. The development of community-acquired pneumonia, an acute respiratory infectious disease that damages the lung parenchyma, caused by the invasion of pathogenic microorganisms, can lead to respiratory failure with multiorgan failure due to respiratory sepsis. CASE PRESENTATION: Case report of a 38-year-old mixed-race woman with diabetes mellitus and irregular treatment, who was admitted with community-acquired pneumonia complicated by type I respiratory failure requiring mechanical ventilation. During her hospital stay, she developed ventilator-associated pneumonia, recurrent empyema, bronchopleural fistula, refractory septic shock and multiorgan dysfunction despite multiple interventions. The patient required prolonged mechanical ventilation, vasopressor support and antibiotic therapy. After 62 days, metastatic papillary thyroid carcinoma was diagnosed. She presented with hypoparathyroidism and permanent hypocalcemia. She died after multiple complications and a refractory critical condition. CONCLUSION: The case exemplifies the potential severity of community-acquired pneumonia in a patient with risk factors such as diabetes and immunosuppression. It highlights the complexity of treating multiple comorbidities and the importance of multidisciplinary management with close surveillance for timely interventions for complications.

Tumores faciales en un paciente con múltiples neoplasias / Facial tumours in a patient with multiple neoplasms

No disponible

A presença de tireoidite linfocitária crônica influencia o estadiamento tumoral do carcinoma diferenciado da tireoide? / Does chronic lymphocytic thyroiditis influence the staging of differentiated thyroid carcinoma?

A associação entre carcinoma diferenciado de tireoide (CDT) e tireoidite linfocitária crônica (TLC) tem sido relatada na literatura. OBJETIVO: Avaliar a incidência desta associação e determinar se a TLC pode influenciar no estadiamento tumoral do CDT quando associada a outras variáveis de risco. FORMA DE ESTUDO: Coorte histórica (retrospectiva). MATERIAL E MÉTODO: Avaliaram-se 52 prontuários e laudos de pacientes portadores de CDT, no período de 1999 a 2009, divididos em dois grupos. O primeiro, composto de 35 pacientes portadores de CDT sem TLC; o segundo, com 17 pacientes, associado à TLC. O tratamento instituído para todos os pacientes foi a tireoidectomia total. Variáveis comuns a ambos os grupos como idade, gênero, padrão histológico, diâmetro tumoral, metástase locorregional e à distância, invasão extratireoidiana, multifocalidade e presença de cápsula tumoral foram comparadas. Aplicou-se os testes t-Student e Qui-quadrado para análise dos dados. RESULTADOS: A incidência de CDT isolado foi maior do que a de CDT+TLC (p=0,0126). Nenhuma diferença estatística quanto às variáveis comuns analisadas foi observada. CONCLUSÕES: A presença de TLC ocorreu em 33 por cento dos pacientes com CDT. Todos os casos de CDT eram em estádios iniciais.

The association between differentiated thyroid carcinoma (DTC) and chronic lymphocytic thyroiditis (CLT) has been reported in literature. AIM: To evaluate the incidence of this association and to determine whether the CLT may influence on the early initial staging of DTC when associated with other variable risks. STUDY DESIGN: Historical (retrospective) cohort. MATERIALS AND METHODS: Fifty two patients with DTC were evaluated from 1999 to 2009. They were divided into two groups. The first group had 35 patients with DTC without DLT; the second had 17 patients with CLT. Total thyroidectomy was the treatment chosen for all patients. Similarities shared in both groups such as age, gender, histological tumor type, tumor diameter, regional only or with distant metastases, extrathyroidal invasion, multifocality and presence of tumor capsule were considered. T-Student tests and Chi-square tests were applied to analyze the data. RESULTS: The incidence of DTC without CLT was higher that of DTC+CLT (p=0.0126). We noticed no statistic differences between the common variables analyzed. CONCLUSIONS: CLT occurred in 33 percent of the patients with DCT. All cases of DTC were in the early stages.

Adenoma folicular con cambios mucinosos-un hallazgo infrecuente en la patología tiroidea / An unusual finding in thyroid pathology: follicular adenoma with mucinous change

El objetivo de este artículo es presentar un caso infrecuente de adenoma folicular de tiroides productor de mucina. Es un tumor benigno tiroideo encapsulado que afecta en su mayor parte a mujeres de edad media. Suele presentarse como un nódulo solitario con un tamaño medio entre 1-3 cm. En el patrón histológico muestra una arquitectura macro-microfolicular con presencia de mucina intersticial y en estructuras lacunares. Puede tener cambios a células en anillo de sello o a células claras. Con hematoxilina-eosina, la mucina es basófila, es roja con tinción de mucicarmin y azul con alcian blue, siendo de positividad variable para la tinción con PAS y PAS-diastasa. De igual modo muestra positividad para la mucina tipo MUC1. Las células epiteliales muestran positividad para tiroglobulina, importante en el diagnóstico diferencial, siendo el material mucoide negativo para este marcador. En la revisión de la literatura encontramos 13 casos con mucina en adenomas foliculares y 29 casos en carcinomas primarios tiroideos de distinta índole. Haciendo un recuento anual en nuestros casos con presencia de mucina ocasional, sean adenomas o carcinomas primarios tiroideos, el hallazgo de estos cambios mucinosos focales supone una frecuencia entre 0,25-0,8%, aproximadamente un caso o menos de cada 150 de estas neoplasias. En conclusión, la producción de mucina es un hallazgo no habitual en los adenomas tiroideos. En el diagnóstico diferencial debe considerarse la posibilidad de metástasis u otros tumores tiroideos no derivados del epitelio folicular (AU)

Mucin producing thyroid adenoma is a rare entity affecting mainly middle-aged women. It is a benign, encapsulated tumour presenting as a solitary nodule 1 to 3 cm in size with a macro-microfollicular architecture with areas of interstitial mucin. Occasionally, signet-ring or clear cells are present. The mucin is seen to be basophilic with H&E, stains red with mucicarmin and blue with alcian blue. It is variable for PAS and PAS-Diastase, but shows positivity for MUC1. The epithelial cells stain positive for thyroglobuline, but the mucin is negative. We have found 13 cases of follicular adenomas and 29 cases of thyroid carcinomas with mucinous production in the literature. In our experience, this feature is found in 0.25% to 0.8% of thyroid neoplasms or 1 in 150 annually. In conclusion, mucin production is rare in thyroid adenomas and metastases or other thyroid tumours, including those not derived from the follicular epithelium, in the differential diagnosis (AU)

Hombro doloroso y metástasis en escápula secundaria a carcinoma folicular tiroideo / Painful shoulder and metastasis in the scapula secondary to follicular thyroid cancer

Habitualmente el carcinoma folicular de tiroides se presenta como un nódulo tiroideo solitario, y excepcionalmente, como una metástasis. En el carcinoma folicular tiroideo después de la vía hematógena y las metástasis en pulmón, el tejido óseo es el segundo lugar más frecuente de dichas metástasis. Se presenta el caso clínico de una mujer de 70 años, que refería dolor en el hombro izquierdo de intensidad moderada-severa y resistente al tratamiento farmacológico, sin sintomatología general acompañante (pérdida de peso, hiporexia y astenia). La radiografía simple y la tomografía computarizada evidenciaron la reabsorción ósea de la escápula. Se trató con radioterapia externa con evolución clínica favorable. El objetivo de la presentación de este caso clínico es enfatizar la etiología de un dolor de hombro, refractaria al tratamiento, que excepcionalmente tenía su origen en un carcinoma tiroideo bien diferenciado de estadio II, diagnosticado 13 años antes (AU)

Follicular thyroid cancer commonly occurs as a solitary thyroid nodule and rarely as metastasis. Following the dematogenous route and lung metastasis, the second most frequent site of these metastases in follicular thyroid cancer is the bone tissue. A clinical case is presented of a 70-year old woman who reported drug treatment-resistant moderate-severe left shoulder pain, without general accompanying symptoms (weight loss, hyporexia and asthenia). The simple x-ray and computed tomography showed bone resorption of the scapula. She was treated with external radiotherapy with good clinical course. We are presenting this clinical case in order to stress the etiology of a shoulder pain that is refractory to treatment and which, uncommonly, originated in a stage II well-differentiated thyroid cancer diagnosed 13 years ago (AU)

Carcinoma basocelular sobre dermatofibroma / Basal cell carcinoma overlying a dermatofibroma

La epidermis situada sobre un dermatofibroma puede mostrar cambios que varían desde la hiperplasia simple hasta la proliferación de células basaloides, que puede llegar a ser morfológicamente indistinguible del carcinoma basocelular. La coexistencia de un verdadero carcinoma basocelular sobre dermatofibroma es poco frecuente. Habitualmente, estas proliferaciones basaloides se han considerado el resultado del efecto inductivo de la proliferación fibrohistiocitaria del dermatofibroma sobre las células epiteliales del folículo piloso, por lo que se trataría de un fenómeno reactivo y no verdaderamente neoplásico. Describimos un caso de dermatofibroma que presenta en la epidermis suprayacente una proliferación de aspecto basaloide idéntica a un carcinoma basocelular

The epidermis over a dermatofibroma may show changes that range from simple hyperplasia to the proliferation of basaloid cells, which can become morphologically indistinguishable from basal cell carcinoma. The existence of a true basal cell carcinoma overlying a dermatofibroma is infrequent. These basaloid proliferations have usually been considered to be the result of the inductive effect of the fibrohistiocytic proliferation of the dermatofibroma on the epithelial cells of the hair follicle; therefore, it would be a reactive phenomenon and not truly neoplastic. We describe a case of dermatofibroma that presented with a basaloid proliferation identical in appearance to a basal cell carcinoma on the overlying epidermis

Biología molecular del carcinoma de tiroides de estirpe folicular. Bases moleculares en la oncogénesis tiroidea / No disponible

Existen datos que nos permiten afirmar que probablemente, en gran parte de los casos, no existe una solución de continuidad entre las diferentes neoplasias tiroideas de estirpe folicular. Cabe pensar que el proceso evolutivo comienza con una serie de alteraciones moleculares que condicionan la aparición del adenoma folicular (AF). Cambios posteriores propiciarán el desarrollo de un carcinoma folicular (CF). La aparición del carcinoma papilar (CP) tiene probablemente un itinerario similar sin que esté demostrado que tenga su origen en AF. Ulteriores cambios genéticos, tanto en el CP como en el CF encaminarán hacia la indiferenciación celular y con ello el desarrollo del carcinoma indiferenciado (CI). Esta sucesión de alteraciones moleculares condiciona un empeoramiento en el pronóstico de la neoplasia tiroidea. Por ello, las neoplasias tiroideas constituyen un excelente modelo para el estudio de la cronología de los cambios moleculares que condicionan la evolución desde la benignidad a la malignidad. Se ha comprobado que en algunas neoplasias de tiroides existe inestabilidad genética que favorece dichos cambios moleculares. Como fenómeno inicial es frecuente observar alteraciones en los protooncogenes mientras que las mutaciones en los genes supresores de tumor suelen ser un evento tardío. La aparición de agresividad o invasividad de la neoplasia también se puede investigar mediante el estudio de cambios moleculares. La aplicación clínica de dichos hallazgos comienza a ser una realidad, lo que facilitará la precisión diagnóstica y con ello una terapéutica más eficaz (AU)

According to current data, it seems probable that there is no interruption in the evolution of different follicular thyroid neoplasm. Probably transforming events responsible for the transition from normal to tumor cells start with molecular changes that determine the appearance of follicular adenoma. Later changes propitiate the development of follicular cancer. It is likely that the generation of papillary carcinoma follows a different pathway without passing through a previous phase of follicular adenoma. Subsequently, genetic changes render the cell prone to a failure to differentiate, culminating in the development of anaplastic cancer. Those incidental molecular changes result in a dramatic worsening in the prognosis of thyroid cancer. Research into thyroid tumors is likely to be instructive in view of the spectrum they span, from benign adenomas to poorly differentiated carcinomas. It has been proven that molecular alterations in thyroid tumor cells are predisposed by genome instability. Usually changes of protooncogenes represent an early event whereas mutations of suppressant genes are usually a late phenomenon. The onset of aggressive or invasive behavior may be studied, and perhaps can be predicted in the future, by molecular changes. The clinical application of the growing understanding of gene alterations involved in thyroidal oncogenesis is becoming a reality. Such knowledge might contribute, in the near future, to greater diagnostic accuracy and effective treatment for thyroid malignancies (AU)