RESUMO
A 67-year-old woman was admitted to our hospital because of breathlessness. Systemic amyloidosis had been diagnosed 5 years previously. Her chest X-ray film showed multiple nodules in both lung fields. Chest computed tomography (CT) revealed some of the nodules had calcifications. Bronchoscopy demonstrated amyloid deposits in the bronchial walls. The serum titer of anti-SS-A antibody was high. Results of both the Schirmer Test and the Rose-Bengal Test were positive. The final diagnosis was systemic amyloidosis with Sjögren's syndrome. She was treated by chemotherapy using high dose melphalan with autologous peripheral blood stem cell transplantation (PBSCT). It was obvious that her chest X-ray film findings and bronchoscopic findings had improved 9 months after high dose chemotherapy with PBSCT. The disappearance of M protein and improvement of thirst, a symptom of Sjögren's syndrome, were also observed.
Assuntos
Amiloidose/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Melfalan/administração & dosagem , Transplante de Células-Tronco de Sangue Periférico , Síndrome de Sjogren/complicações , Idoso , Amiloidose/complicações , Amiloidose/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Dexametasona/administração & dosagem , Doxorrubicina/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Nódulo Pulmonar Solitário/complicações , Nódulo Pulmonar Solitário/tratamento farmacológico , Transplante Autólogo , Vincristina/administração & dosagemRESUMO
A 61-year-old man was admitted to our hospital with cough, breathlessness, anorexia and chest pain. Chest radiograph showed right pleural effusion and also a chest CT scan showed right pleural effusion with thickening of the right visceral pleura, pericardial effusion and a liver tumor. The pleural effusion was slightly bloody and exudative. The adenosine deaminase (ADA) level in the pleural effusion was elevated. Because the cytological examintion of the pleural effusion showed no malignancy, we diagnosed pleuritis tuberculosa. The serum-soluble interleukin-2 receptor level was also elevated. His general condition worsened in spite of the chemotherapy with antibiotics and antituberculous drugs. We finally diagnosed the case as natural killer (NK) cell lymphoma from CT-guided needle biopsy just before death, and necropsy. In this case, the high level of ADA in the pleural effusion suggested lymphoma.
Assuntos
Adenosina Desaminase/metabolismo , Células Matadoras Naturais , Linfoma não Hodgkin/diagnóstico , Derrame Pleural Maligno/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Pleura/patologia , Derrame Pleural Maligno/enzimologiaRESUMO
The patient was a 69-year-old man who complained of dyspnea and severe general fatigue. Chest CT showed a large tumor (6 x 5 cm) in the left S3 together with left pleural effusion. Despite pleurodesis and chemotherapy, he died 1.5 months after admission. At autopsy, a final diagnosis of pulmonary carcinosarcoma was obtained. We have summarized 17 cases of pulmonary carcinosarcoma reported in Japan. All patients were men, and had an average age of 68 years. The majority of the patients were heavy smokers. Death was reported in 70% of cases, the median survival period being 5 months, whereas the patients reported as living had operable cases of T2 tumor without distant metastatic lesions.