Hallazgo incidental de neoplasia primaria de pulmón: blastoma pulmonar en mujer adulta. Reporte de caso / Incidental finding of primary lung neoplasm: pulmonary blastoma in an adult woman, case report

El blastoma pulmonar es una neoplasia poco común y agresiva que se origina en el pulmón; está compuesto por tejido mesenquimal y epitelial inmaduro que imita la configuración pulmonar en etapas embrionarias. Tiene una baja incidencia y una alta tasa de mortalidad, con aproximadamente un 60 %. Este blastoma tiende a desarrollarse con mayor frecuencia entre la cuarta y quinta década de vida, siendo más prevalente en mujeres y generalmente asociado al tabaquismo. Se presenta el caso de una mujer de 23 años sin factores de riesgo conocidos, a quien se le diagnosticó incidentalmente un blastoma pulmonar primario. La paciente experimentaba dolor en la región costal izquierda, tos productiva, disnea y hemoptisis desde hace 30 días. Los hallazgos en las imágenes de rayos X y tomografías de tórax llevaron a la realización de una biopsia del pulmón izquierdo, que reveló fragmentos de tejido con una notable presencia de necrosis tumoral. Cinco días después, la paciente consultó nuevamente debido a un empeoramiento de los síntomas, incluyendo dolor torácico de tipo pleurítico. Se decidió realizar una lobectomía inferior izquierda, durante la cual se encontró un tumor sólido adherido a la pleura visceral, con masas tumorales en la pleura parietal. El estudio histopatológico final confirmó el diagnóstico de un tumor maligno de alto grado compatible con blastoma pulmonar. En conclusión, el blastoma pulmonar es una neoplasia rara que puede presentarse en diferentes etapas de la vida, aunque tiene mayor incidencia entre los 40 y 50 años. Es importante que los patólogos consideren esta enfermedad en sus diagnósticos diferenciales debido a los desafíos que implica su diagnóstico. Detectar el blastoma pulmonar en etapas tempranas es crucial para el tratamiento adecuado, aunque actualmente no se conocen marcadores predictivos confiables y el pronóstico de esta enfermedad es generalmente desfavorable.

Pulmonary blastoma is a rare and aggressive neoplasm that originates in the lung. It is composed of immature mesenchymal and epithelial tissue that mimics the embryonic configuration of the lung. It has a low incidence and a high mortality rate, of approximately 60%. Pulmonary blastoma tends to occur more frequently between the fourth and fifth decades of life, being more prevalent in women and generally associated with smoking. The case of a 23-year-old woman with no known risk factors is presented, who incidentally was diagnosed with a primary pulmonary blastoma. The patient experienced pain in the left costal region, productive cough, dyspnea, and hemoptysis for 30 days. Findings on X-ray and chest tomography led to a biopsy of the left lung, which revealed tissue fragments with significant tumor necrosis. Five days later, the patient consulted again due to worsened symptoms, including pleuritic chest pain. It was decided to perform a left lower lobectomy, during which a solid tumor attached to the visceral pleura with tumor masses in the parietal pleura was found. The final histopathological study confirmed the diagnosis of a high-grade malignant tumor compatible with pulmonary blastoma. In conclusion, pulmonary blastoma is a rare neoplasm that can occur at different stages of life, although it has a higher incidence between the ages of 40 and 50. Pathologists need to consider this disease in their differential diagnoses due to the challenges involved in its diagnosis. Detecting pulmonary blastoma at early stages is crucial for appropriate treatment, although currently there are no reliable predictive markers, and the prognosis of this disease is generally unfavorable.

Constrictive Pericarditis and Cardiac Tamponade Due to Tuberculosis as Presentation of Human Immunodeficiency Virus/Syndrome of Acquired Immunodeficiency: Case Report / Pericarditis constrictiva y taponamiento cardíaco por tuberculosis como presentación de virus de inmunodeficiencia humana/síndrome de inmunodeficiencia adquirida: presentación de caso / Pericardite constritiva e tamponamento cardíaco devido à tuberculose com uma apre-sentação do vírus da imunodeficiência adquirida: relato de cas

We report a case of constrictive pericarditis due to extrapulmonary tuberculosis associated with Human Immuno-deficiency Virus, complicated by cardiac tamponade that required surgical intervention in a drug user patient. The importance of early diagnosis and management is widely highlighted

El artículo presenta un caso de pericarditis constrictiva secundaria a tuberculosis extrapulmonar en un paciente con prueba positiva para virus de inmunodeficiencia humana (VIH) consumidor de sustancias psicoactivas, quien durante la hospitalización desarrolló un taponamiento cardíaco con requerimiento de intervención quirúrgica. Se plantea la discusión de la importancia de cada una de las pruebas solicitadas y el manejo adecuado en pacientes con dichas patologías

O artigo apresenta um caso de pericardite constritiva secundária à tuberculose extrapulmonar em paciente com teste positiva para vírus da imunodeficiência humana (HIV) e usuário de substâncias psicoativas que, durante a internação, desenvolveu tamponamento cardíaco com necessidade de intervenção cirúrgica. Discute-se a importância de cada um dos exames solicitados e o manejo ade-quado de pacientes com essas patologias

Is there any relationship between massive ascites and elevated CA-125 in systemic lupus erythematosus? Case report and review of the literature.

Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease of variable presentation. Massive ascites in the context of SLE is infrequent. Even so, it has been reported that ascites may be the first manifestation of SLE. It is difficult to diagnose due to the multiple possible aetiological causes of ascites. There is a rare entity called Pseudo-Pseudo Meigs Syndrome (PPMS) in patients with SLE who have ascites, pleural effusion, and CA-125 elevation unrelated to malignancy. We present two cases of massive ascites, pleural effusion and elevation of CA-125 with a history of SLE diagnosis. One of these cases was diagnosed with PPMS and another associated with neoplasm of ovarian origin.

Perilymphatic micronodular pattern as a manifestation of pulmonary amyloidosis on high-resolution computed tomography.

The term amyloidosis describes a group of diseases caused by the fibrillar deposit of poorly folded proteins in tissues with a secondary alteration of their function. Diffuse parenchymal lung disease associated with amyloidosis is rare and is most often diagnosed in autopsy. A 45-year-old male patient presented an acute episode of cough with mucoid expectoration. He had also dyspnea, dry cough, chest pain, and constitutional symptoms of 6 months of evolution. Initially the case was treated as acute pneumonia. After taking radiological images of the thorax, a diagnostic suspicion of lymphangitic spread of neoplasia was assumed. Histopathological findings of an open pulmonary biopsy demonstrated interstitial thickening with perivascular eosinophilic invasion. Congo Red staining and immunohistochemistry studies were done and turned out to be positive for amyloid. The perilymphatic micronodular pattern as a radiological manifestation of parenchymal pulmonary amyloidosis has been very rarely described in the literature, therefore it must be considered as a differential diagnosis in patients with this pattern in CT scan and should be an incentive for its histopathological study once a neoplasm is ruled out.

Multiple DICER1-related tumors in a child with a large interstitial 14q32 deletion.

Germ-line interstitial deletions involving the 14q32 chromosomal region, resulting in 14q32 deletion syndrome, are rare. DICER1 is a recently described cancer-predisposition gene located at 14q32.13. We report the case of a male child with a ∼5.8 Mbp 14q32.13q32.2 germ-line deletion, which included the full DICER1 locus. We reviewed available clinical and pathological material, and conducted genetic analyses. In addition to having congenital dysmorphic features, the child developed multiple DICER1 syndrome-related tumors before age 5 y: a pediatric cystic nephroma (pCN), a ciliary body medulloepithelioma (CBME), and a small lung cyst (consistent with occult pleuropulmonary blastoma Type I/Ir cysts seen in DICER1 mutation carriers). He also developed a cerebral spindle-cell sarcoma with myogenous differentiation. Our investigations revealed that the deletion encompassed 31 protein-coding genes. In addition to the germ-line DICER1 deletion, somatic DICER1 RNase IIIb mutations were found in the CBME (c.5437G > A, p.E1813K), pCN (c.5425G > A, p.G1809R), and sarcoma (c.5125G > A, p.D1709N). The sarcoma also harbored a somatic TP53 mutation: c.844C > T, p.R282W. Additional copy number alterations were identified in the CBME and sarcoma using an OncoScan array. Among the 8 cases with molecularly-defined 14q32 deletions involving DICER1 and for whom phenotypic information is available, our patient and one other developed DICER1-related tumors. Biallelic DICER1 mutations have not previously been reported to cause cerebral sarcoma, which now may be considered a rare manifestation of the DICER1 syndrome. Our study shows that DICER1-related tumors can occur in children with 14q32 deletions and suggests surveillance for such tumors may be warranted.

Sarcoidosis en un atleta de alto rendimiento con patrón recidivante en "árbol en gemación" / Sarcoidosis with a recurrent tree-in-budpattern in a high-performance athlete

La sarcoidosis es una enfermedad granulomatosa crónica sistémica de origen desconocido que afecta principalmente el pulmón, pero podría afectar cualquier órgano. Su diagnóstico es de exclusión haciendo necesaria una estricta correlación clínica, radiológica y patológica para su aproximación diagnóstica, adecuado tratamiento y seguimiento. Presentamos un caso de un paciente joven, atleta de alto rendimiento, con una manifestación radiológica infrecuente...

Sarcoidosis is a chronic systemic granulomatous disorder of unknown origin. It predominantly affects the lungs, but it can affect any organ. Sarcoidosis is a diagnosis of exclusion. A strict clinical, radiological and histopathological correlation is required for diagnosis and adequate treatment and follow-up. Herein we present the case of a young high-performance male athlete with an unusual radiological finding...

Linfoma primario del mediastino (tímico): Presentación de caso / Primary Mediastinal Lymphoma (Thymic): A Case Report

Los linfomas mediastinales anteriores pueden hacer parte del linfoma sistémico y comprenden aproximadamente el 50 % de los tumores mediastinales. El linfoma no Hodgkin primario del mediastino es un subtipo de menor prevalencia, representando un 10 % de los casos; este tiene dos subtipos histológicos que son el linfoma T linfoblástico y el linfoma B difuso de célula grande. Este último es agresivo y tiende a infiltrar la pleura, las estructuras óseas y el pulmón; se origina de las células B de la médula del timo. En este artículo se describe un caso de linfoma no Hodgkin primario del mediastino del subtipo B difuso de células grandes, sus hallazgos por imágenes, patología y una breve revisión de la literatura.

Anterior mediastinal lymphomas may be part of systemic lymphoma and they comprise approximately 50 % of mediastinal neoplasms. Primary non-Hodgkin's lymphoma of the mediastinum is a subtype with lower prevalence, representing 10 % of all cases; it has two histologic subtypes that include T-cell lymphoblastic lymphoma and diffuse large B-cell lymphoma. The latter is an aggressive neoplasm that tends to infiltrate the pleura, bone structures and the lung; it originates from thymic medullary B cells. This article presents a case of primary non-Hodgkin's lymphoma of the mediastinum with diffuse large B-cell subtype, its radiologic findings, pathology and a brief review of the literature.