Resección de carcionama gigante de la corteza suprarrenal: un caso clínico / Resection of giant adrenal cortical carcinoma: a case report

OBJETIVO: Presentamos un caso de carcinoma gigante de la corteza suprarrenal no funcional al que se le realizó una extirpación completa en nuestro departamento. MÉTODO: Caso clínico y la evolución de un caso de carcinoma gigante de la corteza suprarrenal al que se le realizó una extirpación completa. RESULTADO: Una mujer de 49 años solicitó atención médica por dolor abdominal en el cuadrante superior derecho. Durante la investigación, se le realizó a la paciente una tomografía computada (Figura 1) en la que se observó un gran tumor que ocupaba la topografía suprarrenal derecha con áreas que parecían indicar necrosis, en contacto directo con el hígado, empujando el riñón derecho hacia abajo y extendiéndose a línea media. Después de una hipótesis de carcinoma maligno, se tomaron muestras de sangre para evaluar la hipersecreción hormonal, las cuales dieron como resultado niveles característicos de una neoplasia adrenal no funcional. El tratamiento que se eligió fue la extirpación del tumor; la porción quirúrgica extirpada presentó 21 cm. en su diámetro mayor y un peso de 2.106 gramos. Microscópicamente era un carcinoma de la corteza suprarrenal. CONCLUSIONES: las opciones para el tratamiento de carcinoma de la corteza suprarrenal no mostraron progresos significativos en las últimas décadas; el tratamiento quirúrgico es aún la mejor opción, lo que fomenta la realización de una cirugía importante aun en pacientes con grandes masas tumorales

OBJETIVE: We report a case of nonfunctioning giant adrenal cortical carcinoma undergoing complete resection. METHODS: We report the case and evolution of a woman who underwent resection of a giant adrenal carcinoma at Santa Marcelina Hospital. RESULTS: A 49-year-old female presented with palpable mass in the right hypochondrium extending 5 cm down from the right costal margin. Abdominal CT Scan found a large mass occupying the right adrenal region with areas suggestive of necrosis, in close contact with the liver, pushing the right kidney inferiorly and extending to the midline. Biochemical tests to evaluate hormonal secretion resulted in levels within the normal range characteristic of a non-functioning adrenal neoplasm. The treatment of choice was resection of the abdominal mass; the surgical specimen greatest diameter was 21 cm and weighed 2106 grams. It was an adrenal cortical carcinoma. CONCLUSIONS: Options for the treatment of adrenal cortical carcinoma showed no significant advances in recent decades and complete surgical resection remains the most effective treatment for adrenal cortical carcinoma, even in patients with bulky tumor masses

Resection of giant adrenal cortical carcinoma: a case report.

OBJECTIVE: We report a case of nonfunctioning giant adrenal cortical carcinoma undergoing complete resection. METHODS: We report the case and evolution of a woman who underwent resection of a giant adrenal carcinoma at Santa Marcelina Hospital. RESULTS: A 49-year-old female presented with palpable mass in the right hypochondrium extending 5 cm down from the right costal margin. Abdominal CT Scan found a large mass occupying the right adrenal region with areas suggestive of necrosis, in close contact with the liver, pushing the right kidney inferiorly and extending to the midline. Biochemical tests to evaluate hormonal secretion resulted in levels within the normal range characteristic of a non-functioning adrenal neoplasm. The treatment of choice was resection of the abdominal mass; the surgical specimen greatest diameter was 21 cm and weighed 2106 grams. It was an adrenal cortical carcinoma. CONCLUSIONS: Options for the treatment of adrenal cortical carcinoma showed no significant advances in recent decades and complete surgical resection remains the most effective treatment for adrenal cortical carcinoma, even in patients with bulky tumor masses.

Clinical and laboratory profile of HIV-positive patients at the moment of diagnosis in Bahia, Brazil.

In Brazil, current trends of the AIDS epidemic include an increase in transmission through heterosexual contact, predominantly from men to women, with more cases of AIDS in women and more children contaminated by vertical transmission. There is also a high proportion of cases in poor people or people living in small towns. HIV-infected patients with high levels of immunodeficiency are frequently hospitalized after their first visit to the clinic due to opportunistic infections, characteristic of advanced disease. This study characterized the clinical and laboratory pattern of AIDS in a sample of patients attended for the first time in the AIDS clinic of the Federal University of Bahia Hospital (HUPES) in Salvador, Brazil. We revised medical charts of cases of subjects registered at the outpatient AIDS clinic from January 1997 to December 2003. The demographics, clinical data, and laboratory characteristics were analyzed to determine the degree of immunodeficiency at the time of admission. A total of 377 patients were evaluated (58.6% were male, with a mean sample age of 33.4 years). The most frequent clinical manifestations were asthenia, weight loss, fever, anemia, dermatitis, oral thrush and diarrhea. CDC criteria were not adequate to define the initial cases. After admission to the outpatient clinic, nearly 25% of the patients were hospitalized immediately, indicating delay in the diagnosis. In Bahia, the initial presentation of HIV-infected patients to health care assistance is occurring at a late stage of the disease, when signs and symptoms of immunodeficiency are already established. Efforts are necessary to construct strategies to make an early diagnosis of these patients, improve the quality of care, and guarantee the benefits of antiretroviral therapy, when it is indicated.

Clinical and laboratory profile of HIV-positive patients at the moment of diagnosis in Bahia, Brazil

In Brazil, current trends of the AIDS epidemic include an increase in transmission through heterosexual contact, predominantly from men to women, with more cases of AIDS in women and more children contaminated by vertical transmission. There is also a high proportion of cases in poor people or people living in small towns. HIV-infected patients with high levels of immunodeficiency are frequently hospitalized after their first visit to the clinic due to opportunistic infections, characteristic of advanced disease. This study characterized the clinical and laboratory pattern of AIDS in a sample of patients attended for the first time in the AIDS clinic of the Federal University of Bahia Hospital (HUPES) in Salvador, Brazil. We revised medical charts of cases of subjects registered at the outpatient AIDS clinic from January 1997 to December 2003. The demographics, clinical data, and laboratory characteristics were analyzed to determine the degree of immunodeficiency at the time of admission. A total of 377 patients were evaluated (58.6 percent were male, with a mean sample age of 33.4 years). The most frequent clinical manifestations were asthenia, weight loss, fever, anemia, dermatitis, oral thrush and diarrhea. CDC criteria were not adequate to define the initial cases. After admission to the outpatient clinic, nearly 25 percent of the patients were hospitalized immediately, indicating delay in the diagnosis. In Bahia, the initial presentation of HIV-infected patients to health care assistance is occurring at a late stage of the disease, when signs and symptoms of immunodeficiency are already established. Efforts are necessary to construct strategies to make an early diagnosis of these patients, improve the quality of care, and guarantee the benefits of antiretroviral therapy, when it is indicated.