RESUMO
Multiple round opacities suggestive of metastatic lung tumors were incidentally found on a chest x-ray film in a 43-year-old woman. The patient underwent hysterectomy for "myoma uteri" three years previously. Extensive examinations could not specify the primary neoplastic lesions. Morphological characteristics of the thracoscopically resected lung tumors suggested low-grade endometrial stromal sarcoma (ESS), and immunostaining revealed that the tumor cells were positive for progesterone and estrogen receptors, CD10 and vimentin, confirming a diagnosis of ESS. ESS is an uncommon uterine neoplasm, however, may be mistaken as benign tumors such as epithelioid leiomyoma, and occasionally metastasizes to remote organs such as lungs even after long disease-free period, posing diagnostic challenge.
Assuntos
Neoplasias do Endométrio/patologia , Neoplasias Pulmonares/secundário , Sarcoma do Estroma Endometrial/patologia , Adulto , Feminino , HumanosRESUMO
Scedosporium apiospermum, a ubiquitously distributed saprophyte, is emerging as an important pathogen in immunocompromised patients. We describe a 72-year-old patient with chronic S. apiospermum infection of the lung simulating aspergilloma. His medical history was unremarkable except that he had undergone partial lung resection as a treatment for pulmonary tuberculosis several decades previously. He had no underlying immunosuppressive conditions. This patient illustrates that pulmonary scedosporiosis is not confined to immunocompromised patients and that the clinical presentation may be indistinguishable from that of aspergilloma.
Assuntos
Aspergilose/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Scedosporium , Idoso , Diagnóstico Diferencial , Humanos , Pneumopatias Fúngicas/patologia , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/microbiologia , Infecções Oportunistas/patologia , Scedosporium/isolamento & purificação , Tuberculose/cirurgiaRESUMO
A 42-year-old woman sought medical attention because of a suddenly developed neck mass. Chest radiography disclosed bilateral pleural effusion, which turned out to be chylothorax. Although lymphatic leakage was suspected, no underlying cause was identified. Her condition resolved spontaneously in seven days. A few similar cases have been described in the literature, and are collectively referred to as "spontaneous bilateral chylothorax".
Assuntos
Quilotórax/diagnóstico por imagem , Adulto , Feminino , Humanos , RadiografiaRESUMO
We treated a 42-year-old man with pulmonary tuberculosis presenting as a round mass in a cavitary lesion that resembled a fungus ball. These findings appeared within a short time. The diagnosis was confirmed by isolation of Mycobacterium tuberculosis from his sputum. He also had diabetes mellitus that was poorly controlled. The patient was treated with antituberculous chemotherapy and insulin therapy. With these treatments, the roentgenographic abnormalities resolved fairly rapidly.
Assuntos
Tuberculose Pulmonar/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Humanos , Pneumopatias Fúngicas/diagnóstico por imagem , Masculino , Radiografia TorácicaRESUMO
Diffuse pulmonary small nodules and pyrexia suddenly developed in a 27-year-old woman during immunosuppressive treatment for viral-associated hemophagocytic syndrome. Miliary tuberculosis was suspected, however, bone marrow biopsy did not support the diagnosis. Lung biopsy revealed interstitial pneumonitis admixed with characteristic inclusion-bearing cells, and cytomegalovirus (CMV) DNA was demonstrated in polymerase chain reaction using bronchoalveolar lavage cells, establishing the diagnosis of CMV pneumonitis. No other opportunistic pathogens were identified, and the pneumonitis was subsided due to administration of gancyclovir. The present case illustrates CMV pneumonitis as a differential diagnosis for small nodular opacities which develop in immunocompromised patients.
Assuntos
Infecções por Citomegalovirus/diagnóstico , Pneumonia Viral/diagnóstico , Adulto , Infecções por Citomegalovirus/diagnóstico por imagem , Infecções por Citomegalovirus/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/patologia , RadiografiaRESUMO
This phase II study was conducted to investigate the efficacy and safety of irinotecan (CPT-11) and ifosfamide as second-line chemotherapy for relapsed small cell lung cancer (SCLC). Eligibility criteria included histologically or cytologically confirmed SCLC, prior chemotherapy including platinum + etoposide, and measurable or evaluable disease. CPT-11 (80 mg/m(2)) was administered intravenously on days 1, 8 and 15, while ifosfamide (1.5 g/m(2)) was given on days 1 through 3 every 4 weeks. Thirty-four patients (29 men) with a median age of 69 years (range 42-77) and a median Eastern Cooperative Oncology Group (ECOG) performance status of 1 (range 0-2) were enrolled. The response rate was 52.9% (95% confidence interval: 29.8-64.9%) with 2 complete responses and 16 partial responses. Our analyses of prognostic factors showed risk factors assessed before receiving second-line chemotherapy, which were the number of metastatic sites, performance status and the type of relapse. WHO grade 3-4 neutropenia was recorded in 52.9% of the patients, grade 3 diarrhea in 5.9%. The combination of CPT-11 and ifosfamide demonstrated clinical efficacy in relapsed SCLC with a favorable toxicity profile, particularly for performance status 0-1 and sensitive cases with only one metastatic site.