RESUMEN
Background and objective Invasive prolactinoma accounts for 1-5% of all prolactinomas. Its mass and compromise of the diencephalon and frontal and temporal lobes may result in a range of neuropsychiatric symptoms that are often missed during initial evaluations. Cabergoline is a dopaminergic agonist used as the first-line treatment for these patients; however, its effect on neuropsychiatric symptoms in this particular setting remains unexplored. In this study, our primary objective was to describe the epidemiology of neuropsychiatric comorbidities in Mexican patients with invasive prolactinomas. The secondary aim of the study was to describe how these comorbidities are modified by treatment with cabergoline, through follow-up with standardized clinical scales. Methods This was a retrospective analytic study. Data were pulled from clinical records and evaluations of patients at baseline and at six-month follow-ups. Results A total of 10 patients were included in the study. None of them had any prior psychiatric diagnosis. At the initial evaluation, 70% were diagnosed with depression or anxiety. During follow-up, two patients developed neuropsychiatric symptoms; there was a significant reduction in tumor size but no difference was found in clinimetric scores for neuropsychiatric comorbidities. Conclusions Patients with giant prolactinomas may present with several neuropsychiatric symptoms throughout the course of their disease. Although there are several mechanisms involved, it is important to keep in mind that cabergoline may interfere with the dopaminergic pathways involved. This study was underpowered to determine the association but can serve as a pilot for further research on this topic.
RESUMEN
BACKGROUND: Castleman´s disease is a rare, benign condition of lymphoid tissue. There are two clinical types: unicentric and multicentric with three histological variants, hyaline-vascular, plasma celular and mixed. The most common sites of this are mediastinum, adbomen and neck. Magnetic resonance imaging is well suited to depict the characteristics of the masses and their relationship to adjacent structures. The knowledge of this disease and its inclusión in the differential diagnosis from other neck masses will contribute to the therapeutic approach. CLINICAL CASE: A 21 years old female patient with a left neck mass characterized by magnetic resonance as solid, heterogeneous, vascularized lesión, pre dominantly isointensa on T1-weighted images an high signal on T2-weighted images and fat sat that demonstrate moderate enhancement after contraste material administration located in posterior space of the neck with extensión at thoracic outlet displacing structures of carotid, anterior cervical and viceral spaces. She underwent complete surgical resectión of the mass with histopathological diagnosis of hyaline-vascular type of Castleman´s disease. CONCLUSION: Magnetic resonance is well suited to depict characteristic and the extent of mass in the neck contributing to narrow the differential diagnosis. Imaging findings, especially of magnetic resonance are very important to choose the treatment of Castleman´s disease.
INTRODUCCIÓN: la enfermedad de Castleman es una condición benigna poco frecuente que afecta al tejido linfático. Existen dos formas clínicas: unicéntrica y multicéntrica, así como tres variantes histológicas: hialino vascular, de células plasmáticas y mixta. Los sitios más afectados son el mediastino, abdomen y cuello. La resonancia magnética detalla las características de las masas y su relación con las estructuras adyacentes. El conocimiento de esta enfermedad y su inclusión en el diagnóstico diferencial de las masas cervicales contribuirán en la conducta terapéutica. CASO CLÍNICO: paciente femenina de 21 años con masa cervical izquierda caracterizada por resonancia magnética como lesión sólida, heterogénea, vascularizada, predominantemente isointensa en T1, hiperintensa en T2 y saturación grasa, con moderado realce postcontraste, localizada en el espacio cervical posterior y extensión al opérculo torácico que desplaza las estructuras de los espacios: carotídeo, visceral y cervical anterior. Fue sometida a resección quirúrgica completa con diagnóstico histopatológico de enfermedad de Castleman de tipo hialino vascular. CONCLUSIÓN: la resonancia magnética detalla las características y extensión de las masas cervicales contribuyendo a estrechar el diagnóstico diferencial. Los hallazgos de imagen, especialmente de la resonancia magnética son importantes para elegir el tratamiento en la enfermedad de Castleman.
