Giant tubular adenoma of the breast in a child female – Case report / Adenoma tubular gigante de mama en mujer adolescente – caso clínico

Tubular adenoma of the breast is one of the rarest benign tumors and little is known about this entity. Some cases of giant tubular adenoma of breast have been reported, but till the moment the largest lesion described in literature was a case of a 18 cm tubular adenoma in 31-year-old women. In this case report of a 12-year-old patient, we present the largest giant tubular adenoma of the breast ever described. It was an atypical presentation, not only due to the tumor size, but also due to the absence of a clear cleavage plan with the breast tissue in the physical exam and its rapid growth. (AU)

El adenoma tubular de mama es uno de los tumores benignos más raros y poco se conoce sobre esta entidad. Se han reportado algunos casos de adenoma tubular gigante de mama, pero hasta el momento la lesión más grande descrita en la literatura fue un caso de adenoma tubular de 18 cm en una mujer de 31 años. En este caso clínico de una paciente de 12 años, presentamos el adenoma tubular gigante de mama más grande jamás descrito. Fue una presentación atípica, no solo por el tamaño del tumor, sino también por la ausencia de un plan de clivaje claro con el tejido mamario en el examen físico y su rápido crecimiento. (AU)

Jejunum cavernous haemangioma - A rare cause of gastrointestinal bleeding.

We report a case of a 69-year-old male patient with gastrointestinal bleeding manifesting with melaena. Upper and lower endoscopy were negative for the bleeding aetiology. On small bowel capsule endoscopy, several violaceous lesions in the proximal jejunum were identified. The patient was submitted to segmental intestinal resection being diagnosed with a cavernous jejunum haemangioma, a rare cause of acute intestinal bleeding.

Ovarian Leydig Cell Tumor: Cause of Virilization in a Postmenopausal Woman.

BACKGROUND Only 0.5% of all ovarian tumors are Leydig cell tumors and they are generally benign and unilateral. These androgen-secreting tumors lead to virilizing symptoms, most often in postmenopausal women. Because Leydig cell tumors are typically small, diagnosing them accurately can be challenging. CASE REPORT We report the case of a 77-year-old woman who was referred to our Endocrinology Clinic because of a 5-year history of hirsutism (Ferriman-Gallwey score of 11) with no discernible cause. The patient had high levels of serum testosterone and a normal level of dehydroepiandrosterone sulfate. Imaging, including transvaginal ultrasound and pelvic magnetic resonance, revealed a 16-mm uterine nodule, which was suspected to be a submucous leiomyoma, but no adrenal or ovarian lesions. Despite the lack of findings on imaging and because of the high suspicion for an androgen-secreting ovarian tumor, bilateral laparoscopic oophorectomy was performed. Histological examination of the specimen revealed a non-hilar Leydig cell tumor that measured 8 mm in its largest axis. After the surgery, the patient had significant clinical improvement and her laboratory test results normalized. Her sister had the same symptoms and laboratory findings at a similar age, which raised the suspicion of a possible familial genetic syndrome. No genetic testing was performed, however, because the patient's sister declined further diagnostic investigation. CONCLUSIONS Leydig cell tumors are rare, and even when they are small, they can cause symptoms related to androgen excess. As a result, diagnosing them often is challenging.

Severe intrahepatic cholestasis, erythrocytosis and hypoglycemia: unusual presenting features of systemic AL amyloidosis.

We report the case of a 68-year-old African woman who presented with jaundice, hepatomegaly and anasarca. Clinical investigation disclosed severe intrahepatic cholestasis, nephrotic syndrome, erythrocytosis and hypoglycemia. Diagnosis of systemic AL amyloidosis was established by percutaneous liver biopsy. Bone marrow biopsy showed 32% of myeloma cells. The patient started treatment with melphalan and prednisolone, but liver function deteriorated and she died in hepatic failure complicated by septic shock three weeks after the diagnosis. We present possible explanations for the unusual clinical and laboratory findings, which required a multidisciplinary approach and posed challenging problems in differential diagnosis and management.

[Cardiac papillary fibroelastoma]. / Fibroelastoma papilar cardíaco.

Cardiac papillary fibroelastoma is a rare and histologically benign tumor. It is the most common valvular tumor and preferentially is found in the aortic valve (44% of the cases). They are typically smaller than 1 cm in diameter, and are characterized by having a fibrous core with elastic fibers, connective tissue and an endothelial lining. Papillary fibroelastoma are typically diagnosed incidentally during TEE. Tumor or thrombus embolizations may lead to severe complications such as stroke, myocardial infarction or even sudden death. In patients with the preoperative diagnosis of papillary fibroelastoma in addition to histories of cardiovascular and cerebrovascular injury require surgical resection to reduce the risk of future embolizations. The authors present two clinical cases of cardiac papillary fibroelastoma who were operated on in the Cardiothoracic Department from 2005 to 2006.

Cardiopatía isquémica en el diabético: su relación con otros factores de riesgo / Ischemic cardiopathy in the diabetic: its relationship to other risk factors

Se estudiaron 101 pacientes diabéticos: 42 tipo 1 y 59 tipo II en busca de cardiopatía isquémica y factores de riesgo coronario, y 100 pacientes no diabéticos que constituyeron el grupo control. Influyeron en forma individual en la aparición de cardiopatía isquémica, la hipercolesterolemia, la hipertension arterial, la edad y el hábito de fumar. No se demostró influencia de la diabetes mellitus como factor aislado en la aparición de la cardiopatía isquémica, se observó en los diabéticos una marcada susceptibilidad a la enfermedad coronaria cuando estuvieron presentes otros factores.

Cardiopatía isquémica en el diabético: su relación con otros factores de riesgo / Ischeic cardiopathy in the diabetic: its relationship to other risk factors

Se estudiaron 101 pacientes diabéticos: 42 tipo 1 y 59 tipo II en busca de cardiopatía isquémica y factores de riesgo coronario, y 100 pacientes no diabéticos que constituyeron el grupo control. Influyeron en forma individual en la aparición de cardiopatía isquémica, la hipercolesterolemia, la hipertension arterial, la edad y el hábito de fumar. No se demostró influencia de la diabetes mellitus como factor aislado en la aparición de la cardiopatía isquémica, se observó en los diabéticos una marcada susceptibilidad a la enfermedad coronaria cuando estuvieron presentes otros factores.

Alteraciones hemogasométricas en fumadores / Hemogasometric alterations in smokers

Se realiza un estudio de los parámetros hemogasométricos en 50 individuos presuntamente sanos, fumadores; los resultados se han comparado con los obtenidos en 50 sujetos no fumadores y 38 neumópatas crónicos, en su mayoría asmáticos de largo tiempo de evolución. El estudio comprende las determinaciones de la presión parcial de CO2, presión parcial de O2 y saturación de la hemoglobina, así como dosificación de carboxihemoglobina. Se obtuvieron elevaciones significativas de HbCO y disminución marcada de los valores de HbO y de la PO2, lo cual evidencia un deterioro en la función pulmonar

Alteraciones hemogasométricas en fumadores / Heogasometric alterations in smokers

Se realiza un estudio de los parámetros hemogasométricos en 50 individuos presuntamente sanos, fumadores; los resultados se han comparado con los obtenidos en 50 sujetos no fumadores y 38 neumópatas crónicos, en su mayoría asmáticos de largo tiempo de evolución. El estudio comprende las determinaciones de la presión parcial de CO2, presión parcial de O2 y saturación de la hemoglobina, así como dosificación de carboxihemoglobina. Se obtuvieron elevaciones significativas de HbCO y disminución marcada de los valores de HbO y de la PO2, lo cual evidencia un deterioro en la función pulmonar