A 64-year-old woman with primary synovial sarcoma of the abdominal wall.

Synovial sarcoma (SS) usually affects joints, bursae, and tendons of extremities and is very infrequent in the head and neck, abdomen, thorax, prostate and kidney, skin, blood vessels, and nerves. Primary intra-abdominal SS is exceeding uncommon and has non-specific symptoms or compress surrounding structures. The diagnosis is a challenge, and histopathological and immunohistochemical studies must confirm the hypothesis. We report the case of SS that has origin in peritoneal structures and a longstanding unsuspected course. The patient was a 64-year-old woman who claimed chronic pain in the left iliac fossa, without additional symptoms. She related laparoscopic oophorectomy, cholecystectomy, and abdominal hysterectomy in the previous three decades. There was neither local invasion nor lymph nodal, vascular or neural invasion, and her surgical treatment by open abdominal procedure was uneventful. The herein reported case aims to enhance the index of suspicion.

Ileal neuroendocrine tumor: diagnosis by endoscopic capsule / Tumor neuroendocrino ileal: diagnóstico por cápsula endoscópica

The diagnosis of neuroendocrine tumors of the small intestine is usually challenging. They are infrequent, and the clinical course is insidious with nonspecific manifestations. Routine endoscopic and abdominal imaging studies are more often unremarkable. Therefore, distant metastases are frequently detected at the time of diagnosis. The tumor markers chromogranin A, synaptophysin, and neuron-specific enolase, and capsule endoscopy, and device-assisted enteroscopy are useful resources to establish a diagnosis. The aim was to present a case of neuroendocrine tumor of small intestine diagnosed with base in findings of the capsule endoscopy and further open surgery.

El diagnóstico de tumores neuroendocrinos del intestino delgado suele ser un desafío. Son infrecuentes y el curso clínico es insidioso con manifestaciones inespecíficas. Los estudios de imágenes endoscópicos y abdominales de rutina suelen ser anodinos. Por tanto, las metástasis a distancia se detectancon frecuencia en el momento del diagnóstico. Los marcadores tumorales cromogranina A, sinaptofi-sina y enolasa neuronal específica, y la cápsula endoscópica y la enteroscopía asistida por dispositivo son recursos útiles para establecer un diagnóstico. El objetivo de este trabajo fue presentar un caso de tumor neuroendocrino de intestino delgado diagnosticado con base en hallazgos de la cápsula endoscópica y de una nueva cirugía abierta.

Rectal Metastases of Breast Carcinoma: A Case Report.

The scarcely reported hematogenous rectal metastases from breast cancer are rare and the diagnosis is challenging. They may be recognized before, concomitantly with, or after the diagnosis of the primary site of breast cancer. Invasive lobular cancer is the histological type more frequently described, and most of the affected patients have a late diagnosis. Tardive recognition is associated with poor outcomes, despite the management options. Endoscopic and imaging evaluations, mainly magnetic resonance studies, are useful, but the anatomopathological findings are mandatory to confirm the diagnostic hypothesis. We describe a middle-aged woman with advanced rectal metastases of unsuspected breast cancer found during the evaluation of manifestations due to intestinal implants. One must highlight long-term follow-up of breast cancers even if seeming in remission. The aim of this report is to enhance the suspicion index of primary health care workers.

Pneumonia in a patient with lung cancer / Pneumonia em paciente com câncer pulmonar

The aim of the present report is to alert health care workers about a 64­year­old patient diagnosed with adenocarcinoma in the right lung treated with pemetrexed disodium, cisplatin and dexamethasone. He evolved with prolonged neutropenia, symptoms of lower airways infection, and recent pulmonary infiltrate in the radiographic image. The cultures for bacteria and mycobacteria in the blood and sputum were negative. Because of the lack of response to treatment with broad spectrum antibiotics and maintenance of neutropenia, a transbronchial biopsy was performed, which demonstrated infection by Aspergillus fumigatus. The patient was treated.

O objetivo do presente relato é alertar os profissionais de saúde sobre o caso de um paciente de 64 anos de idade com diagnóstico de adenocarcinoma no pulmão direito tratado com pemetrexede dissódico, cisplatina e dexametasona. Ele evoluiu com neutropenia prolongada, sintomas de infecção de vias aéreas inferiores e infiltrado pulmonar recente na imagem radiográfica. As culturas para bactérias e micobactérias no sangue e escarro foram negativas. Por falha na resposta ao tratamento com antibióticos de largo espectro e manutenção da neutropenia, foi realizada biópsia transbrônquica que demonstrou infecção por Aspergillus fumigatus e o paciente foi tratado.

[Miliary tuberculosis: the role of necropsy studies].

This case study of generalized miliary tuberculosis in a Brazilian man without AIDS is reported in order to emphasize the role of histopathological study for diagnosis. We comment on a recent Indian study involving 40 cases of surgical and necropsy specimens in which the diagnosis of tuberculosis was made, as well as a previous Brazilian case report. The authors believe that non-specialists should be better informed about the possibility of miliary tuberculosis, which involves clinical diagnostic challenges. Despite limitations, minimally invasive necropsy may be an alternative to elucidate causes of death in low-income countries.