ABSTRACT
Paragangliomas are rare tumors, with a reported incidence of 2-8 per million. They are chromaffin cell tumors that develop from the neural crest cells and may be divided in tumors derived from the parasympathetic or sympathetic ganglia. We report a case a of a 32-year-old nulliparous woman, referred to our Infertility Clinic. Abdomino-pelvic ultrasound identified a large abdominopelvic tumor, without ovarian origin (both ovaries were identified and had normal morphology). Magnetic Resonance Imaging suggested a right adnexal multicystic, vascularized mass close to iliac vessels and questioning an ovarian origin. At exploratory laparotomy, a 10 cm encapsulated and vascularized mass was found beginning just below right renal artery and extending to the level of the broad ligament. This mass was totally excised and histopathology was consistent with Paraganglioma.
Os paragangliomas são tumores raros com uma incidência descrita de 2-8 por milhão. São tumores de células cromafins do sistema neuroendócrino que provêm dos gânglios simpáticos ou parassimpáticos. Apresentamos um caso de uma jovem de 32 anos, nulípara referenciada à nossa Unidade de Infertilidade. No decurso da investigação, na ecografia abdomino-pélvica identificámos a presença de uma massa que se estendia da pélvis ao abdómen, desde ovário direito até junto dos vasos renais, cujo ponto de partida era extra-ovárico (foram identificados os dois ovários com características morfológicas normais). A ressonância magnética revelou uma massa anexial multiquística e muito vascularizada junto aos vasos ilíacos, tendo colocado em hipótese origem ovárica. Desta forma, procedemos a uma laparotomia exploradora e encontrámos uma massa encapsulada, muito vascularizada que se estendia desde o bordo inferior da artéria renal direita até ao ligamento largo direito. A massa foi totalmente removida e a histologia foi consistente com um Paraganglioma.
Subject(s)
Abdominal Neoplasms , Paraganglioma , Pelvic Neoplasms , Abdominal Neoplasms/diagnosis , Abdominal Neoplasms/surgery , Adult , Female , Humans , Paraganglioma/diagnosis , Paraganglioma/surgery , Pelvic Neoplasms/diagnosis , Pelvic Neoplasms/surgeryABSTRACT
Diabetic mastopathy (DMP) is an uncommon collection of clinical, radiological, and histological features, classically described in premenopausal women with long-term insulin-dependent diabetes mellitus. This entity can mimic breast carcinoma, but, in the appropriate clinical and imaging setting, the diagnosis can be made by core biopsy, avoiding unnecessary surgeries. We report the case of a 34-year-old female, with a 12-year history of type 1 diabetes, who presented with bilateral breast lumps. Mammography, ultrasonography, and magnetic resonance imaging could not exclude the suspicion of malignancy, and a core biopsy was performed showing the typical histologic features of DMP. The literature is briefly reviewed.
Subject(s)
Diabetes Mellitus, Type 1/diagnosis , Fibrocystic Breast Disease/diagnosis , Fibrocystic Breast Disease/etiology , Magnetic Resonance Imaging , Ultrasonography, Mammary , Breast Neoplasms/diagnosis , Diagnosis, Differential , Female , Humans , Syndrome , Young AdultABSTRACT
Introducción y objetivos: El cáncer de mama constituye un grupo heterogéneo de tumores. La positividad para receptores de estrógenos se ha considerado como un factor de buen pronóstico. Este concepto ha ido cambiando con el estudio de series mayores y seguimientos más largos. El objetivo de esta revisión ha sido evaluar el patrón de recidiva de estos tumores con tiempos de seguimiento más largos. Materiales y métodos: Se llevó a cabo un estudio de revisión de casos en el que se compararon las recidivas entre tumores hormonodependientes y hormonoindependientes. Se evaluaron los casos de recidiva, local y sistémica, diagnosticados entre 1996 y 2010, con un total de 88 casos. La distribución de los casos fue: a) 65 de tumores hormonodependientes; b) 20 de tumores hormonoindependientes, y c) 3 desconocidos. El 99% de los pacientes con tumores con receptores de estrógenos positivos realizó tratamiento endocrino adyuvante. Resultados: El patrón de recidiva de los tumores hormonoindependientes empezó con un pico a los 2 años, y después disminuyó de forma abrupta. Este patrón difirió de los hormonodependientes, con un pico de recidiva entre el tercer y el sexto año, y posteriormente disminuyó de forma gradual durante seguimientos más largos (15-20 años). La regresión logística con la variable dependiente "sin recidiva a los 5 años" mostró una asociación con el tamaño del tumor (p = 0,029) y la positividad para receptores de estrógeno (p = 0,05). No hubo relación para las restantes variables incluidas en el modelo (edad, menopausia, afectación ganglionar, clasificación TNM). Conclusión: Estos datos confirman un patrón de recidiva diferente en los 2 grupos estudiados. Los carcinomas hormonodependientes tuvieron un riesgo de recidiva más elevado, alrededor de los 4-6 años, y posteriormente una disminución gradual. Por el contrario, en sólo el 16,8% de los tumores hormonoindependientes hubo recidiva después de los primeros 5 años de seguimiento(AU)
Introduction and aims: Breast cancer is a heterogeneous group of tumours. The oestrogen receptor positivity was seen as a good prognostic factor for recurrence and survival. This concept has changed with studies with longer follow-up and larger series. It is believed that this effect of better prognosis in hormone-dependent tumours is lost after the first five years of monitoring. Materials and methods: A case review study comparing recurrence between hormone-dependent tumours and tumours with negative oestrogen receptors was undertaken. We evaluated the cases of recurrence, local and systemic, diagnosed between 1996 and 2010, totalling 88 cases. Sixty-five cases were oestrogen receptor positive, 20 cases oestrogen receptor negative, and 3 cases unknown. Almost all (99%) patients with oestrogen receptor positive tumours received adjuvant hormone therapy. Results: The pattern of recurrence in negative estrogen receptors tumors began with an initial peak at 2 years, then steadily decreasing. This pattern differed from the hormone-dependent tumours, with a peak incidence of recurrence between the third and sixth years, and then gradually decreasing over longer follow-ups (15 to 20 years). Logistic regression with the dependent variable "without recurrence at 5 years follow-up" showed an association between tumour size (p=.029) and hormone-dependency (p=.05). No relationship was found in the remaining variables of the model (age, menopausal status, lymph node involvement, TNM classification). Conclusion: These data confirm a different pattern of recurrence in both groups. Hormone-dependent carcinomas had a higher risk of recurrence at about 4 to 6 years and then gradually decreased. By contrast, only 16.8% of negative oestrogen receptors tumours had a recurrence after the first 5 years of follow-up(AU)
