ABSTRACT
La papilomatosis juvenil (PJ) es una lesión mamaria benigna, poco frecuente y de carácter proliferativo. Se caracteriza por ser una proliferación exofítica multifocal de varios papilomas dentro de un segmento mamario. Generalmente afecta a mujeres jóvenes de menos de 30 años de edad. Suele presentarse como una tumoración mamaria indolora, simulando un fibroadenoma. La biopsia percutánea guiada por ecografía permitirá detectar la naturaleza de la lesión y descartar patología maligna asociada. Se describe una serie de 2 casos con similar presentación clínica pero difiriendo en el manejo una vez analizados los antecedentes familiares y las circunstancias individuales de cada uno de ellos
Juvenile papillomatosis (JP) is a rare breast lesion of a proliferative and benign nature. It is noted for being a multifocal exophytic proliferation of several papillomas within a breast segment. It usually affects young women under 30 years of age, and usually presents as a painless breast mass, simulating a fibrous adenoma. The ultrasound guided percutaneous biopsy will enable the diagnosis to be confirmed, as well as to rule out any associated malignant disease. A description is presented on series of 2 cases with similar clinical presentation, but differing in management after analysing the family history and the individual circumstances of each of them
Subject(s)
Humans , Female , Pregnancy , Adult , Papilloma/diagnostic imaging , Papilloma/surgery , Breast Neoplasms/diagnostic imaging , Papilloma, Intraductal/diagnostic imaging , Papilloma, Intraductal/surgery , Mastectomy/instrumentation , Image-Guided Biopsy/methods , Breast Neoplasms/surgery , Biopsy, Fine-Needle/instrumentation , Magnetic Resonance Imaging , Ultrasonography, Mammary/methods , Pregnancy ComplicationsABSTRACT
Antecedentes y objetivo: El procedimiento de punción-aspiración con aguja fina ecoguiada de nódulos tiroideos con examen citológico in situ del material extraído puede reducir el número de citologías obtenidas de categoría Bethesda I. El objetivo del estudio ha sido evaluar nuestra experiencia del segundo año en dicha técnica para analizar la eficacia diagnóstica, la prevalencia y los factores predictores de los resultados de categoría Bethesda I. Pacientes y método: Estudio retrospectivo sobre 279 nódulos en 233 pacientes. La punción-aspiración se realizó según los criterios de 2015 de la American Thyroid Association. Una muestra de cada punción se fijó al aire y se procesó in situ mediante tinción con Diff-Quik y examen microscópico para valorar su idoneidad; en caso contrario, se repitió la punción hasta un total de 5veces. La eficacia diagnóstica se valoró en base a la sensibilidad y a la especificidad sobre las categorías citológicas Bethesda II y Bethesda VI. Resultados: La sensibilidad y la especificidad diagnóstica fueron del 100% en ambos casos. Obtuvimos un 5,4% de resultados de categoría Bethesda I y las variables independientemente asociadas fueron la edad (incremento del 4,7% por cada año de vida) y el volumen del nódulo (incremento del 2,3% por cada 1ml de volumen). Conclusiones: La punción-aspiración ecoguiada con aguja fina y examen citológico in situ del material extraído permite obtener una elevada eficacia diagnóstica y demuestra ser un procedimiento de gran validez por conseguir una tasa muy baja de resultados citológicos de categoría Bethesda I, cuyo riesgo ha sido superior en sujetos de mayor edad y en nódulos de mayor tamaño
Background and objective: Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination may decrease the number of Bethesda category I cytologies. The study objective was to evaluate our second-year experience with this procedure to analyze diagnostic efficacy, prevalence, and factors predicting for Bethesda category I results. Patients and method: A retrospective study was conducted of 279 nodules from 233 patients. Ultrasound -guided fine needle aspiration was performed according to the 2015 criteria of the American Thyroid Association. A specimen of each aspiration was air-fixed on site before Diff-Quik staining and microscopic examination to assess its suitability; otherwise, nodule aspiration was repeated up to 5 times. Diagnostic efficacy was assessed based on sensitivity and specificity on the cytological categories Bethesda II and Bethesda VI. Results: Diagnostic sensitivity and specificity were both 100%, 5.4% Bethesda category I results were obtained, and variables independently associated were age (4.7% increase per year of life) and nodule volume (2.3% increase per each 1mL of volume). Conclusions: Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination allows for a high diagnostic efficacy and has been shown to be a highly relevant procedure because it has a very low rate of cytological results of Bethesda category I, whose risk has been higher in older subjects and with larger nodules
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Biopsy, Fine-Needle/instrumentation , Thyroid Nodule/diagnosis , Thyroid Nodule/epidemiology , Predictive Value of Tests , Biopsy, Fine-Needle/methods , Thyroid Nodule/pathology , Thyroid Gland/cytology , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Introducción: La elastografía guiada por ultrasonografía endoscópica es considerada una herramienta útil en la evaluación de las lesiones solidas pancreáticas (LSP). Objetivo: El objetivo del estudio fue evaluar el rendimiento diagnóstico de la elastografia en pacientes con LSP. Material y métodos: Se realizó un estudio transversal prospectivo en el hospital Rebagliati durante julio 2017 a junio 2018. Se incluyeron pacientes con diagnóstico de LSP y estudio ecoendoscópico, elastografía y toma de PAAF. Se realizó elastografia cualitativa y elastografia cuantitativa (SR e histograma) y se analizó con resultados histopatológicos para determinar la sensibilidad, especificidad, valor predictivo positivo (VPP), valor predictivo negativo (VPN) y exactitud diagnostica en la detección de malignidad. Resultados: De 846 ecoendoscopías, se estudiaron 46 pacientes con LSP con una edad promedio de 64,6 años, 29 (63%) sexo femenino. El adenocarcinoma pancreático fue diagnosticado en 36 casos (78,3%). En elastografía cualitativa predominó el score 3 (n=39, 84,8%) con una sensibilidad, especificidad y exactitud de 88.9%, 30% y 76,1% respectivamente para predecir adenocarcinoma. Elastografía cuantitativa de SR≥ 15 (sensibilidad 100%, especificidad 66,7% y exactitud 97,8%) y un valor de histograma menor de 49 (sensibilidad 66,7%, especificidad 97,6% y exactitud 95,6%) predice malignidad en una LSP con área bajo de la curva ROC de 0,941 (IC 95%, 0,82 - 1,0). Conclusiones: La elastografía brinda información para predecir la naturaleza maligna de la lesión. En nuestro estudio la detección elastográfica de un score 3, SR≥ 15 o un histograma < 49 predice la presencia de malignidad en la LSP estudiada.
Introduction: endoscopic ultrasonography (EUS) elastography is considered a useful tool for the evaluation of solid pancreatic lesions (SPL). Objective: The aim of our study was to evaluate the diagnostic performance of elastography in patients with SPL. Material and methods: A prospective, cross-sectional study was performed at the Rebagliati Hospital between July 2017 and June 2018. Patients with a diagnosis of SPL and echoendoscopic study, elastography and FNA were included. Qualitative and quantitative elastography: strain ratio (SR) and strain histogram, were performed and analyzed with histopathological results. The diagnostic accuracy of EUS elastography in detecting malignancy was calculated using receiver operating curve analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for the detection of malignancy were calculated. Results: Out of 832 EUS examinations performed, 46 patients with SPL (mean age, 64.6 years; 29 women) were included in the study. Pancreatic adenocarcinoma was diagnosed in 36 cases. In qualitative elastography, score 3 was most frequent (n = 39, 84.8%) with sensitivity, specificity and accuracy of 88.9%, 30% and 76.1%, respectively, for predict adenocarcinoma. A strain ratio of 15 or higher (100% sensitivity, 66.7% specificity and 97.8% accuracy) and a histogram of less than 49 (66.7% sensitivity, 97.6% specificity and 95.6% accuracy) predicts malignancy in SPL, with area under a ROC curve of 0.941 (95% CI, 0.82 - 1.0). Conclusions: EUS elastography provides information to predict the malignant nature of the pancreatic lesion. In our study, the elastographic detection of a score 3, SR≥15 or a histogram <49 predicts the presence of malignancy in LSP.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pancreatic Neoplasms/diagnostic imaging , Endosonography , Elasticity Imaging Techniques , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/secondary , Pancreatitis/pathology , Pancreatitis/diagnostic imaging , Video Recording , Adenocarcinoma/pathology , Adenocarcinoma/diagnostic imaging , Cross-Sectional Studies , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Neuroendocrine Tumors/pathology , Neuroendocrine Tumors/diagnostic imaging , Biopsy, Fine-Needle/instrumentation , Biopsy, Fine-Needle/methodsABSTRACT
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Subject(s)
Humans , Biopsy, Fine-Needle/instrumentation , Needles/trends , Angioplasty/methods , Endovascular Procedures/instrumentation , Angiography/instrumentation , Angiography/trendsABSTRACT
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Subject(s)
Humans , Male , Aged , Diarrhea/complications , Carcinoid Heart Disease/complications , Carcinoid Heart Disease , Carcinoid Tumor/complications , Carcinoid Tumor , Heart Failure/complications , Neoplasm Metastasis , Weight Loss , Dyspnea/complications , Diarrhea/etiology , Flushing/complications , Biopsy, Fine-Needle/instrumentation , Somatostatin/therapeutic use , Abdomen/pathology , Abdomen , PrognosisABSTRACT
Introducción. El desarrollo y perfeccionamiento de la ecografía a partir de los setenta supuso un gran avance en el ámbito de la punción aspiración con aguja fina (PAAF), posibilitando localizar lesiones no palpables y minimizar complicaciones. El uso de PAAF ecoguiada trajo como consecuencia que dicha técnica se desplazara por motivos logísticos de los servicios de anatomía patológica a los servicios de radiología. El «alejamiento del patólogo» trajo como consecuencia numerosos inconvenientes. Con la finalidad de recuperar el territorio perdido y optimizar el procedimiento se inició una experiencia pionera y hasta donde sabemos única España en el Servicio de Anatomía Patológica del Hospital Universitario Central de Asturias (HUCA) con la PAAF ecoguiada realizada por citopatólogo. Método. Se cuantificaron todas las PAAF realizadas en el HUCA desde el 1 de julio de 2015 hasta el 30 de junio de 2016. Se procedió a clasificarlas dependiendo de si fueron PAAF ecoguiadas realizadas por patólogo o PAAF no realizada por patólogo, teniendo como principal criterio si fueron valorables o insuficientes. Resultados. Casi la mitad de las PAAF efectuadas fueron realizadas por citopatólogo (923). Las PAAF ecoguiadas realizadas por patólogo superaron en rendimiento diagnóstico a las PAAF no realizadas por patólogo. En todas las localizaciones anatómicas comprables, la PAAF ecoguiada realizada por patólogo tuvo un menor porcentaje de muestras insuficientes (4,33%) en comparación con la PAAF no realizada por patólogo (12,05%). Conclusión. El citopatólogo adecuadamente adiestrado es capaz de realiza PAAF ecoguiada con excelentes resultados. Los buenos resultados obtenidos han traído como consecuencia el aumento progresivo del número de PAAF solicitadas para llevar a cabo en el Servicio de Anatomía Patológica (AU)
Introduction. The development and improvement of ultrasound from the seventies has caused a breakthrough in fine needle aspiration (FNA), allowing the location of non-palpable lesions and minimizing complications. For logistic reasons, ultrasound-guided-FNA (US-FNA) is carried out in the department of radiology. However, the distance from the pathologist has many disadvantages. In order to correct this and thus optimize the procedure, the Department of Pathology at the University Hospital of Asturias (Hospital Universitario Central de Asturias [HUCA]) has initiated, for the first time in Spain, the Ultrasound-Guided-FNA Performed by Cytopathologists programme. We present our experience so far. Method. FNA performed at HUCA were quantified from July 1st 2015 to June 30th 2016. FNA were classified as US-FNA-cytopathologists or US-FNA-without cytopathologists. Criteria of sufficient and insufficient samples were taken into account. Results. Almost half of the FNA were made by cytopathologists (923). The performance of US-FNA-cytopathologists was better than US-FNA-without cytopathologists. US-FNA-cytopathologists had a lower percentage of inadequate samples (4.33%) compared to FNA carried out by non cytopathologists (12.05%). Conclusion. Adequately trained cytopathologists can perform US-FNA with excellent results. Our positive experience has resulted in an increase in the number of requests for FNA to be carried out in the Department of Pathology (AU)
Subject(s)
Humans , Female , Middle Aged , Ultrasonography, Interventional/methods , Biopsy, Fine-Needle/instrumentation , Biopsy, Fine-Needle/methods , Pathology/instrumentation , Pathology/methods , Antisepsis/methods , Ultrasonography/methods , Povidone/therapeutic use , Retrospective Studies , Immunohistochemistry/methods , Positron-Emission Tomography/methodsABSTRACT
ABSTRACT Objectives The presence of thyroglobulin (Tg) in needle washouts of fine needle aspiration biopsy (Tg-FNAB) in neck lymph nodes (LNs) suspected of metastasis has become a cornerstone in the follow-up of patients with papillary thyroid carcinoma (PTC). However, there are limited data regarding the measurement of anti-Tg antibodies in these washouts (TgAb-FNAB), and it is not clear whether these antibodies interfere with the assessment of Tg-FNAB or whether there are other factors that would more consistently justify the finding of low Tg-FNAB in metastatic LNs. Materials and methods We investigated 232 FNAB samples obtained from suspicious neck LNs of 144 PTC patients. These samples were divided according to the patient’s serum TgAb status: sTgAb- (n = 203 samples) and sTgAb+ (n = 29). The TgAb-FNAB levels were measured using two different assays. Tg-FNAB was also measured using two assays when low levels (< 10 ng/mL) were identified in the first assay of the metastatic LNs from the sTgAb+ samples. Results The TgAb-FNAB results were negative in both assays in all samples. Low levels of Tg-FNAB were identified in 11/16 of the metastatic LNs of the sTgAb+ patients and 16/63 of the sTgAb- patients (p < 0.05) using assay 1. The measurement of the Tg-FNAB levels using assay 2 indicated additional metastases in 5 LNs of the sTgAb+ patients. Conclusions Factors other than the presence of TgAb-FNAB may contribute to the higher number of metastatic LNs with undetectable Tg-FNAB in the sTgAb+ group. In addition, the measurement of Tg-FNAB using different assays was useful to enhance the diagnosis of metastatic LNs, particularly when cytological and Tg-FNAB results are discordant.
Subject(s)
Humans , Autoantibodies/blood , Thyroglobulin/blood , Thyroid Neoplasms/blood , Carcinoma/blood , Lymph Nodes/immunology , Reference Values , Carcinoma/immunology , Carcinoma/pathology , Carcinoma, Papillary , Fluoroimmunoassay/methods , Predictive Value of Tests , Biopsy, Fine-Needle/instrumentation , Biopsy, Fine-Needle/methods , Lymph Nodes/pathology , Lymphatic Metastasis/immunology , Lymphatic Metastasis/pathology , NeckABSTRACT
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Subject(s)
Humans , Female , Adult , Masseter Muscle/pathology , Masseter Muscle/surgery , Masseter Muscle , Granular Cell Tumor/complications , Granular Cell Tumor/pathology , Granular Cell Tumor/surgery , Immunohistochemistry/methods , Granular Cell Tumor , Magnetic Resonance Spectroscopy/methods , Biopsy, Fine-Needle/instrumentation , Biopsy, Fine-Needle/methods , Microscopy , Parotid Gland/cytology , Parotid Gland/pathologyABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Discitis/complications , Discitis/drug therapy , Discitis , Streptococcus mitis/isolation & purification , Streptococcus mitis/pathogenicity , Biopsy, Fine-Needle/instrumentation , Biopsy, Fine-Needle/methods , Biopsy, Fine-Needle , Spine , Ceftriaxone/therapeutic use , Levofloxacin/therapeutic use , EchocardiographyABSTRACT
We report a case of a 70-year old woman with a high-grade myxofibrosarcoma which presented as a subcutaneous tumor in the posterior right thigh. Fine-needle aspiration revealed isolated and three-dimensional groups of spindle cells with high-grade atypia and a myxoid background. The cytoarchitecture of the tumor showed non-distinctive, highly cellular spindle cell morphology, whilst other areas had a very prominent myxoid matrix with elongated, curvilinear blood vessels. A few scattered mucin-containing pseudolipoblasts were also observed. The differential diagnosis with other myxoid lesions is discussed; a correct diagnosis is important as the metastatic risk is lower than most types of adult high-grade pleomorphic sarcoma (AU)
Describimos el caso de una mujer de 70 años con un mixofibrosarcoma de alto grado que se presentó como un tumor subcutáneo en la región posterior del muslo. El estudio de punción-aspiración demostró células aisladas y grupos tridimensionales de células fusiformes, con atipia de alto grado y fondo mixoide, con vasos sanguíneos elongados, curvilíneos. Las imágenes citoarquitecturales de este tumor mostraron una morfología fusiforme no distintiva altamente celular, y otras áreas tienen matriz mixoide muy prominente. Además se observaron aislados pseudolipoblastos que contenían mucina. Discutimos brevemente el diagnóstico diferencial con otras lesiones mixoides. La importancia de establecer un diagnóstico correcto tiene implicaciones pronósticas, ya que el riesgo metastásico es menor que en otros tipos de sarcomas pleomórficos de alto grado del adulto (AU)
Subject(s)
Humans , Female , Aged , Fibrosarcoma/diagnosis , Fibrosarcoma/pathology , Immunohistochemistry/methods , Immunohistochemistry , Prognosis , Diagnosis, Differential , Cytological Techniques , Biopsy, Fine-Needle/instrumentation , Biopsy, Fine-Needle/methods , Biopsy, Fine-Needle , Cytodiagnosis/instrumentation , Cytodiagnosis/methods , CytodiagnosisABSTRACT
La afectación ganglionar por Mycobacterium tuberculosis puede ocurrir tras una diseminación linfohemática a partir de una afectación primaria pulmonar, o por primoinfección extrapulmonar, cuya puerta de entrada son las mucosas o contacto con objetos contaminados. Se presenta el caso de un niño de diez años, nacido en España, afecto de adenitis tuberculosa en la región inguinal, cuya infección se produjo tras una herida en el pie ocurrida en una playa de Brasil. Tras el inicio de la terapia antituberculosa desarrolló una escrófula que requirió desbridamiento quirúrgico, con buena evolución posterior (AU)
Tuberculous lymphadenitis can be caused either by an haematogenous spread from a pulmonary primary form or by an extrapulmonary infection due to cutaneous lesions or contact with contaminated items. We present a 10-year-old spanish boy, who has an inguinal tuberculous lymphadenitis. Infection was secondary to a foot injury caused in a Brazilian beach. A scrofula appeared after triple therapy was instaured, needing surgical debridement with a favourable clinical evolution (AU)
Subject(s)
Humans , Male , Child , Lymphadenitis/complications , Lymphadenitis/drug therapy , Lymphadenitis/pathology , Mycobacterium tuberculosis , Mycobacterium tuberculosis/isolation & purification , Polymerase Chain Reaction/methods , Polymerase Chain Reaction/standards , Polymerase Chain Reaction , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Early Diagnosis , Antibiotics, Antitubercular/therapeutic use , Antitubercular Agents/therapeutic use , Tuberculin/analysis , Biopsy, Fine-Needle/instrumentation , Biopsy, Fine-Needle/methods , Tuberculosis, Lymph Node/complications , Tuberculosis, Lymph Node/drug therapyABSTRACT
Son múltiples las patologías torácicas que van a requerir un procedimiento intervencionista tanto para su diagnóstico como para su tratamiento. Por este motivo, el radiólogo debe conocer las indicaciones de cada procedimiento y estar familiarizado con su técnica. En este trabajo se revisarán los diferentes procedimientos intervencionistas que debe conocer el radiólogo y las indicaciones de la punción de lesiones pulmonares, con especial atención a las potenciales diferencias entre la PAAF (punción-aspiración con aguja fina) y la biopsia, en cuanto a resultados diagnósticos y a complicaciones. Se discutirán también las indicaciones de la radiofrecuencia pulmonar. En otro punto se repasarán los conceptos sobre drenaje de abscesos pulmonares. Se hará hincapié tanto en el manejo del derrame pleural, atendiendo a las indicaciones de toracocentesis, y a cuándo realizarla con guía radiológica, como en el protocolo de drenaje pleural. Respecto al derrame pericárdico, se valorarán sus indicaciones y complicaciones. Finalmente, se discutirá el manejo intervencionista de las lesiones mediastínicas con consejos prácticos de cómo abordar estas lesiones evitando graves complicaciones (AU)
Many thoracic conditions will require an interventional procedure for diagnosis and/or treatment. For this reason, radiologists need to know the indications and the technique for each procedure. In this article, we review the various interventional procedures that radiologists should know and the indications for each procedure. We place special emphasis on the potential differences in the diagnostic results and complications between fine-needle aspiration and biopsy. We also discuss the indications for radiofrequency ablation of lung tumors and review the concepts related to the drainage of pulmonary abscesses. We devote special attention to the management of pleural effusion, covering the indications for thoracocentesis and when to use imaging guidance, and to the protocol for pleural drainage. We also discuss the indications for percutaneous treatment of pericardial effusion and the possible complications of this treatment. Finally, we discuss the interventional management of mediastinal lesions and provide practical advice about how to approach these lesions to avoid serious complications (AU)
Subject(s)
Humans , Male , Female , Thorax , Mass Chest X-Ray , Biopsy/methods , Thoracentesis/methods , Thoracentesis , Pleural Diseases/surgery , Pleural Diseases , Biopsy, Fine-Needle/instrumentation , Biopsy, Fine-Needle/methods , Pleural Cavity/pathology , Pleural Cavity , Mediastinum/pathology , Mediastinum , Radio Waves/therapeutic use , Catheter Ablation/methodsABSTRACT
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Subject(s)
Humans , Female , Child, Preschool , Lymphatic Abnormalities/surgery , Lymphatic Abnormalities/therapy , Sclerotherapy/instrumentation , Sclerotherapy/methods , Sclerotherapy , Radiotherapy/instrumentation , Radiotherapy/methods , Doxycycline/administration & dosage , Doxycycline/pharmacology , Doxycycline/therapeutic use , Ultrasonography, Doppler/instrumentation , Ultrasonography, Doppler/methods , Magnetic Resonance Spectroscopy/instrumentation , Magnetic Resonance Spectroscopy/methods , Magnetic Resonance Spectroscopy/therapeutic use , Biopsy, Fine-Needle/instrumentation , Biopsy, Fine-Needle/methods , Biopsy, Fine-NeedleABSTRACT
Osteomielitis del pubis es una patología poco frecuente y se caracteriza por fiebre, dolor pélvico severo, impotencia funcional para la marcha y destrucción ósea de los márgenes de la sínfisis púbica o de sus ramas. Generalmente se describe asociada a complicaciones de diversos procedimientos quirúrgicos en la pelvis, traumatismos, infección del tracto urinario y abuso de drogas por vía intravenosa. Mientras que, la osteomielitis del pubis debida a la infección de la prótesis tras la reparación de la hernia inguinal, es un hecho excepcional. Describimos un caso de osteomielitis de la rama ascendente del pubis en un paciente varón de 88 años de edad, tras hernioplastia inguinal realizada tres meses antes, causada por Estafilococus aureus meticilin resistente, que mejoró tras retirar la malla, limpieza quirúrgica, curetaje óseo, terapia VAC (cicatrización asistida por vacio) y tratamiento antibiótico específico Discutimos la incidencia, etiología, manifestaciones clínicas, diagnóstico, diagnóstico diferencial, tratamiento y prevención de esta patología
Pubic osteomyelitis is a rare disease characterized by fever, severe pelvic pain, and functional disability for walking and bone destruction margin of the pubic symphysis or its branches. Generally described associated to complications of the several surgical procedures in the pelvis, trauma, urinary tract infection and intravenous drug abuse. While, the pubic osteomyelitis due to infection of the prosthesis after inguinal herniarepair is a rarely described entity. We describe a case of osteomyelitis of the pubis ascending branch on a 88-year-old male patient after inguinal hernia repair performed three months earlier, caused by Staphylococcus aureus methicillin resistant, which improved after removing the mesh, surgical cleaning, VAC (Vacuum Assisted Closure) therapy and specific antibiotic treatment. We discuss the incidence, etiology, clinical manifestations, diagnosis, differential diagnosis, treatment and prevention of this disease
Subject(s)
Humans , Male , Aged, 80 and over , Osteomyelitis/complications , Osteomyelitis/etiology , Osteomyelitis/pathology , Hernia, Inguinal/diagnosis , Hernia, Inguinal/therapy , Surgical Mesh , Staphylococcal Infections , Arthritis, Infectious/diagnosis , Arthritis, Infectious/pathology , Disease Prevention , Biopsy, Fine-Needle/instrumentation , Biopsy, Fine-Needle/methods , Biopsy, Fine-NeedleABSTRACT
Hodgkin lymphoma (HL) is an uncommon B cell lymphoid malignancy representing approximately 10-15 % of all lymphomas. HL is composed of two distinct disease entities; the more commonly diagnosed classical HL and the rare nodular lymphocyte-predominant HL. An accurate assessment of the stage of disease and prognostic factors that identify patients at low or high risk for recurrence are used to optimize therapy. Patients with early stage disease are treated with combined modality strategies using abbreviated courses of combination chemotherapy followed by involved-field radiation therapy, while those with advanced stage disease receive a longer course of chemotherapy often without radiation therapy. High-dose chemotherapy (HDCT) followed by an autologous stem cell transplant (ASCT) is the standard of care for most patients who relapse following initial therapy. Brentuximab vedotin should be considered for patients who fail HDCT with ASCT (AU)
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Subject(s)
Humans , Male , Female , /standards , Hodgkin Disease/pathology , Therapeutics/methods , Lymphocytes/cytology , Cell Transplantation/methods , Spain/ethnology , Lymphatic Diseases/complications , Lymphatic Diseases/pathology , Lymph Nodes/metabolism , Biopsy, Fine-Needle/methods , Hodgkin Disease/complications , Hodgkin Disease/diagnosis , Therapeutics/instrumentation , Lymphocytes/physiology , Cell Transplantation/standards , Cell Transplantation , Lymphatic Diseases/genetics , Lymph Nodes/abnormalities , Biopsy, Fine-Needle/instrumentationABSTRACT
A Doença de Graves constitui a forma mais comum de hipertireoidismoem áreas suficientes em iodo (60-80%)10. Por sua vez,o carcinoma papilífero, é o tumor tireoidiano mais frequentee é responsável por 80% dos casos de câncer de tireoide nosEUA12. Carcinomas da tireoide incidentais em pacientes comDG não são incomuns, mas a maioria deles são microcarcinomapapilar de tireoide de baixo risco, sem metástases em linfonodosou invasão extratireoidiana4. Exames complementares quandorealizado por profissionais experientes tornam-se instrumentode grande valia ao diagnóstico. Relata-se o caso de uma pacientefeminina, 41 anos, em seguimento ambulatorial, com sintomastípicos de DG cujos exames iniciais mostravam-se normais ecom subsequente avaliação apresentava nódulo tireoidiano comcaracterísticas de malignidade. A punção aspirativa por agulhafina (PAAF) foi compatível com Carcinoma Papilífero e a terapêuticacirúrgica indicada, seguida de dose ablativa iodo radioativo(131I) e supressiva com levotiroxina (LT4).(AU)
The Graves Disease is one of the most common clinical formsof hyperthyroidism in iodine sufficient areas (60-80%). At the same time, papillary thyroid carcinoma is the most frequent andresponsible for 80% of thyroid cancer cases in US. Incidentalthyroid cancer is common among patients with Graves disease,with no linphonodal metastasis nor local extrathyroidal invasion.Complementary exams performed by experienced physiciansare a valuable diagnostic tool. Here we describe of a 41 yearoldfemale patient that was in outpatient care for classic Graveswith typical symptoms, but with primary exams all normal.In the follow-up examination a single nodule with malignantcharacteristics was visualized and for the patient was indicatedto Fine Needle Aspiration (FNA), which was positive forPapillary Carcinoma. Patient underwent surgical treatmentfollowed by radioactive iodine therapy and a suppressing doseof levothyroxine.(AU)
Subject(s)
Humans , Female , Adult , Thyroid Neoplasms/diagnosis , Graves Disease/pathology , Thyroid Nodule/diagnosis , /drug therapy , Thyroxine/therapeutic use , Biopsy, Fine-Needle/instrumentation , Iodine Radioisotopes/therapeutic useABSTRACT
El fibroadenoma es el tumor mamario benigno más frecuente en las mujeres entre los 20 y 35 años. Hay diferentes variantes, destacando el fibroadenoma gigante sobre el cual presentamos el caso clínico. El fibroadenoma gigante ha sido definido como un fibroadenoma cuyo diámetro máximo es mayor de 5 cm o que pesa más de 500 g. El diagnóstico inicial se basa en la historia clínica y en la examinación física, y el diagnóstico definitivo se realiza mediante el estudio histológico. El tratamiento quirúrgico debe de ser valorado individualmente, optando por la resección en casos de crecimiento muy rápido y casos muy sintomáticos. En los casos en los que existe una asimetría mamaria severa, se podría emplear la técnica de «T» invertida, que es eficaz en la reducción del volumen y la corrección de la ptosis en hipertrofia mamaria, e incluso plantear la mastectomía (AU)
Fibroadenoma is the most common benign breast tumor in women aged between 20 and 35 years. There are different variants, including giant fibroadenoma. We report a case of this entity. Giant fibroadenoma has been defined as a fibroadenoma with a maximum diameter larger than 5 cm or weighing more than 500 g. The initial diagnosis is based on clinical history and physical examination and definitive diagnosis is made by histological analysis. Surgical treatment should be individually assessed and resection is recommended in patients with fibroadenomas with very rapid growth and in highly symptomatic patients. In patients with severe mammary asymmetry, the inverted «T» technique can be used, which is effective in reducing the volume and correcting ptosis in breast hypertrophy. Mastectomy is also an option (AU)
Subject(s)
Female , Humans , Middle Aged , Fibroadenoma/diagnosis , Fibroadenoma/surgery , Mastectomy/instrumentation , Mastectomy/methods , Biopsy, Fine-Needle/instrumentation , Biopsy, Fine-Needle/methods , Biopsy, Fine-Needle , Breast/anatomy & histology , Breast/ultrastructure , Mammography/methods , Mammography , Breast Neoplasms/diagnosis , Breast Neoplasms/surgery , Breast/cytology , Breast/pathology , Breast/surgery , Diagnosis, DifferentialABSTRACT
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Subject(s)
Adult , Humans , Male , Paraneoplastic Syndromes/metabolism , Paraneoplastic Syndromes/pathology , Gangrene/blood , Gangrene/pathology , Angiography/methods , Biopsy, Fine-Needle/instrumentation , Paraneoplastic Syndromes/complications , Paraneoplastic Syndromes/diagnosis , Gangrene/complications , Gangrene/genetics , Angiography/standards , Biopsy, Fine-Needle/methods , Case ReportsABSTRACT
Objetivo Estudiar clínica y epidemiológicamente focos de leishmaniasis visceral (LV) urbana en Neiva (Colombia). Materiales y Métodos Seis niños consultaron por hepato-esplenomegalia. Presentaban anemia y leucopenia. Se realizó biopsia por aspiración de medula ósea (5 pacientes) y de bazo (1 paciente). Se hizo búsqueda activa de casos en la comunidad y de anticuerpos anti-Leishmania infantum por inmunofluorescencia indirecta (IFI) en los sintomáticos y en reservorios caninos (IFI, rK39). Se hicieron visitas domiciliarias para educación comunitaria y búsqueda de vectores. Los pacientes recibieron Miltefosina, Anfotericina B o Glucantime®. Resultados Se confirmó LV en siete niños. En seis, el aspirado de medula ósea o bazo demostró amastigotes. La IFI fue positiva en 4 pacientes y negativa en 3. Un niño se detectó por búsqueda activa comunitaria, con clínica de LV, confirmada por IFI (1:32). La miltefosina no fue útil en 6 de los 7 casos. La Anfotericina B liposomal o deoxicolato, curó 6 pacientes y el Glucantime® uno. La seroprevalencia en 1182 caninos (IFI y rK39) fue de 6.1 %; los animales positivos fueron sacrificados. Se demostró Lu. longipalpis, vector de LV, en el peridomicilio. Conclusiones Demostramos LV urbana en dos comunas de Neiva. La confirmación diagnóstica incluyó aspiración de medula ósea e IFI. La Miltefosina no fue útil. La Anfotericina B liposomal fue la terapia ideal. Para controlar la LV es necesario hacer BAC, educación comunitaria, control de vectores y reservorios.(AU)
Objective Characterize the foci of visceral leishmaniasis infection in Neiva with a clinical and epidemiological approach. Materials and Methods Six children consulted medical services with hepatosplenomegaly. They were found to have anemia and leukopenia. The diagnosis was performed by bone marrow (five patients) and spleen (1 patient) aspiration. An active search for cases was carried out in the community. Anti-Leishmania infantum antibodies were also sought out using indirect immunofluorescence (IIF) in symptomatic patients and in dogs (IFI, rK39). House calls were made in order to carry out educational activities and to collect disease vectors. Patients received miltefosine, amphotericin B or Glucantime®. Results LV was confirmed in seven children. In six of them, the bone marrow or spleen aspirate contained amastigotes. The IIF was positive in 4 patients and negative in 3. One child was detected throught the active community search, confirmed by the clinic with IIF (1:32). Six patients were cured with liposomal amphotericin B (o deoxycholate) and one patient was cured with Glucantime®. The canine seroprevalence in 1182 dogs was 6.1% (IFI and rK39); the positive animals were destroyed. L. longipalpis was found in the houses. This is the principal vector of LV in Colombia. Conclusions The study showed that two zones of Neiva have children infected with LV. Diagnostic confirmation must include aspiration of bone marrow and IIFs. Treatment with miltefosine was not helpful, but liposomal amphotericin B is an ideal therapy. To control LV, active case searching, community education and vector and reservoir control is necessary.(AU)
Subject(s)
Humans , Leishmania infantum , Leishmaniasis, Visceral/pathology , Colombia/epidemiology , Fluorescent Antibody Technique, Indirect/instrumentation , Biopsy, Fine-Needle/instrumentationABSTRACT
El cáncer de laringe es la segunda neoplasia maligna de cabeza y cuello en adultos. Hemos decidido la búsqueda de un método diagnóstico eficaz y eficiente de las tumoraciones laríngeas sospechosas de malignidad. Se realiza la punción aspiración con aguja fina transcartilaginosa laríngea (PAAF TCL) en las lesiones laríngeas de estadios TNM altos (III y IV) como método diagnóstico alternativo a la tradicional biopsia por microcirugía laríngea. Se logra así la optimización de recursos institucionales y el beneficio de los pacientes en función del tratamiento de los mismos.
Laryngeal cancer is the second leading cause ofhead and neck malignant neoplasms in adults. Wedecided to search for effective diagnostic method oflaryngeal tumors suspicious of malignancy. Transcartilaginous Fine Needle Aspiration Biopsy (TF-NAB) is performed in laryngeal lesions of high levelTNM stage (III and IV) as an alternative to traditionalbiopsy by laryngeal microsurgery. It achievesthe optimization of institutional resources and thebenefit of patients according to their treatment.
O câncer de laringe é segunda neoplasia maligna de cabeça e pescoço em adultos. Decidimos buscar um método diagnóstico eficaz e eficiente das tumorações laríngeas com suspeitas de malignidade.Realiza-se a Punção Aspiração com Agulha Fina Transcartilaginosa Laríngea (PAAF TCL) nas lesões laríngeas de estádios TNM altos (III e IV) como método diagnóstico alternativo à tradicional biopsia por microcirurgia laríngea. Obtém-se assim a otimização de recursos institucionais e o benefício dos pacientes em função do seu tratamento.